Introduction
Lung cancer occurs where uncontrolled cell growth spreads in one or both lungs interfering with the normal body function system. The abnormal cell growth divides into masses of tissue known as tumours which interferes with the normal functioning of the lungs-which is to provide bloodstream with oxygen. In cases where cancer cells migrate to other parts of the body, more serious conditions which may be difficult to treat may arise. This case can be seen in Malina case, who is the focus of the case report. The essay will first examine the effects of Malina’s conditions in terms prediction of its occurrence and how she has managed to live with it. Secondly, the numbers of treatment methods and complementary therapies available for lung cancer management and lastly, the provision of continuity of care within a multidisciplinary team setting and Palliative care.
Basic Information
Malina is a 46 year-old white Caucasian female cancer patient living in United Kingdom. She works a full time job as an audit clerk for a construction company and lives with her husband and two teenage children. The patient Malina is case adopted from one presented by Baldwin (2006) with symptoms of fatigue from her full time job as a billing clerk for a construction company and recently had a persistence cough.
Lung cancer disease and the parameters in the prediction of its occurrence
This case study refers to Malina (Baldwin, 2006), a 46 year old non-smoker, who was diagnosed with Non-Small Cell Lung Cancer (NSCLC) and found to have adenocarcinoma. The case study used progression method to study the rapid movement of adenocarcinoma in the lung cancer for a period of two years. The results however indicated that the disease accelerated fast within a short period and even produced advanced form of cancer. It was therefore concluded that management of lung cancer can prove difficult with delayed prognosis and therefore palliative care should be the strategy to increasing quality of life (Baldwin, 2006).
At the beginning of the treatment, the Malina’s home was tested for radon levels and reported no history of asbestos or carcinogens. On diagnosis, the film chest test identified nodule in the patient’s lung and was later diagnosed with NSCLC. Malina was then booked in one month later for the removal of nodular mass that had projected in the lungs. At the time of the surgery, the cancer was discovered to be worse which was later diagnosed to Stage II-B adenocarcinoma. Soon the operation was completed the patient reported to be experiencing gastrointestinal and abdominal pains (Baldwin, 2006).
Living with Lung Cancer
A number of treatment methods have been implemented and complementary therapies including meditation and relaxation are widely used to improve the quality of life of a cancer patient. One of the treatments includes neoadjuvant chemotherapy in Non-Small Cell Lung Cancer (NSCLC) patients undergoing curative surgery in stages I, II, IIIA NSCLC to determine if the treatments can effectively manage lung cancer symptoms (Eldridge, 2009) hence improvement of patients’ quality of life. However, it is important to note that effectiveness of chemotherapy can only be achieved when combined with other treatments. The results produced different degrees of improvement when two treatments of standard radiotherapy and chemotherapy were combined. This therefore brings us to the conclusion that neoadjuvant chemotherapy combined with the best supportive care from health professionals and the family can help the patient achieve quality of life (Eldridge, 2009).
According to Eldridge (2009), about 51% of lung cancer patients experience pain during their treatments. The pain may be caused by a number of factors such as lung lining tumours that keep on pressing nerves and pleura, other diseases associated with the illness include headaches, mouth sores and coughing. Malina first presented flu symptoms in March 2004 that later graduated to fatigue and persistent cough. National Pain Cancer Institute (2008) explains that lung cancer pain may vary from one patient to the other depending on the severity of the disease. According to Eldridge (2009), lung cancer patients are also faced with fears that the pain medication will no longer work and the pain will continue to get worse. He sates that when managing cancer, a patient should be made aware that they will never become immune to the medication and if they ever do which is unlikely, many options are available to alleviate the pain. Patients also faced with fears of associated side effects relating cancer drugs should be made to understand that all medications have side effects but its fairly easy to control them. Many have complained of their inability to afford the pain medication, but the patient can be prescribed less expensive medication or directed financial help centre where they can get help (National Pain Cancer Institute, 2008).
Quality of Life (QOL)
Quality of life is a measurement that is used to evaluate the general well being of an individual, a patient for this case. In management of cancer, quality of life refers to how the disease has negatively affected the person’s degree to enjoy life. My case study will specifically highlight Malina’s case in relations to lung cancer symptoms such as wheeze, tiredness, weigh loss, breathlessness, fatigue and haemoptysis as stated in Baldwin (2006). Malina’s infection with Beijing flu back in 2004 while pregnant with her second child exposed her to ectopic pregnancy hence negatively impacting on her quality of life. The patient was later diagnosed with benign tumour which was later usefully removed following surgery (Baldwin, 2006) also compromised her quality of life. Studies have consistently found that lung cancer inherent burdens, treatments and the related toxics always revolve around patient’s quality of life. Apart from the normal medication, a patient can be referred to various interventional pain treatments such as radiation therapy, chemotherapy or surgery for cases of extreme cancer cases like pressing tumours (Christo & Mazloomdoost, 2008; Dacey et al 2005).
Various forms of treatment of Lung Cancer
In improving the quality of life and management of cancer, many hospitals and cancer centres now offer alternative approaches to control pain. The alternative approaches are used in conjunction with other lung cancer pain treatments and have been reported to effective and great substitute to pain medication in the long run. Christo & Mazloomdoost (2008) mentions the complimentary approaches as hypnosis, acupuncture, therapeutic touch and message therapies (Eldridge, 2009; Dy, 2008).
Once the diagnosis is complete, the patient should be referred to the nearest oncology specialist if possible. Pain addiction medications should also be talked about and any other concerns affecting the patients such as stigma should be approached with delicacy. Principles of care of lung cancer managements require care giver and specialists nurses to ensure a patient receives appropriate specialist support in the pre and post operations. For effective quality support, surgery units should be equipped with High Dependency facilities ready for intensive care support and treatment plans designed around successive case reviews in fully serviced multidisciplinary team meetings (Eldridge, 2009; Ripamonti & Bandieri, 2009).
Radical Radiotherapy for Stage I and Stage II
A study conducted to measure the effectiveness of radiotherapy on NSCLC following a Cochrane and systematic review on the selected evidences collected from 44 retrospective case series including 3,683 patients with doses more than 50Gy/25F (Scottish Intercollegiate Guidelines Network, 2005). It was however concluded that measuring the effectiveness of the treatment was not an easy task because of the un-uniformed entry criteria or the pre-treatment prognostic criteria. The studies however suggested that the treatment was effective in prolonging survival of the patients in both stages of the cancer. Another study of RCT showed the Continuous Hyperfractionated Accelerated Radiation Therapy (CHART) is much more effective that 60Gy/6W in stage II patients (Scottish Intercollegiate Guidelines Network, 2005). A meta-analysis study however concluded that survival benefits for hyper-fractionated radio therapy were higher compared to convectional radio therapy. Another randomised controlled trails measuring how radiation can reduce mobility in combination of other agents or in altering the radiation technique were not adequately looked into. Therefore trail on reducing radiation mobility should be looked into as they may prove effective in lung cancer pain management (Jung et al, 2007; Brady et al, 2006).
Chemotherapy for Stage IIIB and IV
A meta-analysis study conducted by Scottish Intercollegiate Guidelines Network (2005) to evaluate the benefit of chemotherapy provided reports of pain improvement around the sixth week and increased survival rates of up to 10%. The combination of modern chemotherapy such as the paclitaxel, docetaxel and vinorelbine and the best supportive care such as the radiotherapy were seen to increase the quality of life.
Newer approaches for treating cancer such as blocking specific tumour growth receptors does not entirely benefit all lung cancer patients more specifically patients in stages IIIB/IV NSCLC (Scottish Intercollegiate Guidelines Network , 2005). Older patients are reported to respond differently to various treatments compared to younger patients. Older patients should not either be discriminated against chemotherapy treatments as they just may respond well to the treatment compared to single agent therapies (Scottish Intercollegiate Guidelines Network, 2005; Soon et al, 2009)
Malina received chemoradiation therapy on a weekly basis which combined Carboplaton and Pluclitaxol which started soon the patient complained of the pains for a period of 1year four months. Chemotherapy was aimed at prolonging the patient’s life and relieves the symptoms. It was reported that the patient responded well within the first four months of treatment and began exercise and diet program which improved Malina’s general health. Two years later, the patient experienced PET scan changes and small nodules were reported to appear in the trachea together with a mass of bronchoscopy which was later removed. A repeat of PET was performed while awaiting the results and the patient was offered a number of treatments options to choose from which included chemotherapy, radiation, oral Tarceva and Vorino stat for phases I/II and Brachytherapy. The repeated PET scan revealed extended invasion in the pleural space and two small nodules in the liver. This meta-analysis required the patient to review the treatment options provided (Baldwin, 2006).
Multidisciplinary teams
Consistence findings across UK and Scotland emphasised the benefits of multidisciplinary team to benefit lung cancer patients. The findings summarized that caregivers should consistently follow up on the patient to ensure maximum care is achieved. In this case, institutions should adopt patient-centre approach that will ensure effective communication throughout the treatment period (Scottish Intercollegiate Guidelines Network, 2005; Jacobson et al, 2004).
Multidisciplinary team is defined by National Institute for Clinical Excellence (2008) as the a group of health and social care professional from a range of disciplines who meet regularly to discuss and agree plans of treatment and care for people with particular type of cancer or problem, or in a particular location (148).
The benefits of the team roles were identified to be providing fast tract model in reducing waiting times and there positively impacted the nursing interventions. Reports from the Allied Health Professions Palliative Care Project concluded that team participation in lung cancer management combined with palliative care, rehabilitation and supportive interventions enhanced patient’s life (Coory et al, 2008; Moore, 2006; The British Thoracic Society Lung Cancer Working Party, 2005).
A patient should immediately be directed to a multidisciplinary team consisting of specialist nurses, pathologists, respiratory physician, radiologists, thoracic surgeon, pharmacists and allied health care professions once the diagnosis is complete. Once the plan is formulated, a specialised nurse and a physician should explain to the patient about the diagnosis, staging and management of the disease. The patient should be provided with full possessions of both verbal and written information on the subject (Scottish Intercollegiate Guidelines Network, 2005; Forrest, 2005; Barnes and Wilkinson, 2004; Harding & Murtagh, 2006).
Supportive and palliative care of family and friends
Supportive care that includes help from family members in supporting the patient cope with the lung cancer symptoms and treatment is very crucial. Family members should be encouraged to take part in the patient’s life right from pre-diagnosis, through diagnosis to treatment (Simoff & Kvale, 2005). This strategy has is reported to be widely successful in maximising the benefits of treatment. Nurses should therefore give family support an equal opportunity alongside diagnosis and treatment. In palliative care, nurses should take roles in providing holistic care of the patient by providing psychological, social and spiritual support in the best way possible. Palliative should be used in combination with other treatment for maximum efficiency. Also, the specialist palliative care will be needed in patients with far advanced illnesses and required active participation of multi professional team with adequate skills to prove psychological, spiritual, physical and social support. It is for this reason the General Medical Council and NHS Quality Improvement Scotland have provided a new treatment approach by requiring all medical team professional to acquire degree of palliative care skills to adequately care for cancer patients (General Medical Council, 2004; Clinical Standards Board for Scotland, 2005).
Conclusion
Lung cancer patients often experience extreme symptoms compared to other types of cancers. Since Malina’s health improved significantly following chemotherapy treatment, health professionals in this case should therefore ensure the patient attends all the treatment sessions for symptoms management appropriately. Neoadjuvant chemotherapy should be combined with the best supportive care from health professionals and the family can help the patient achieve quality of life. Multidisciplinary team combined with palliative measures should effectively be applied in improving quality of life for cancer patients. Treatment and management of cancer can be successful if the patient is diagnosed in time, therefore, physicians, specialist and doctors should make efforts to observe lung cancer symptoms and offer good prognosis on time.
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