Cancer Flashcards

1
Q

True or False: Cancer is more prevalent in men than women?

A

True

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2
Q

true or False: Colon cancer is the leading cause of cancer in both men and women.

A

False: Lung Cancer

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3
Q

True or false: Cancer is the leading cause of death in America

A

False: Heart Disease. Cancer is #2. However in people over the age of 85, cancer is #1

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4
Q

Protooncogenes

A

Normal cell genes that are important regulators of normal cell processes. They promote growth. Protooncogenes are the genetic lock that keeps the cell in its mature functioning state. This is unclocked by exposure to carcinogens or oncogenic viruses.

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5
Q

Tumor Suppressor genes

A

Suppress growth; regulate cell growth. Mutations that alter TSG can make them inactive, resulting in a loss of their suppressive action. (BRCA1 and BRCA2)

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6
Q

Oncogenes

A

Mutations that alter the expression of protooncogenes. Oncogenes are tumor inducing genes.

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7
Q

BRCA1 and BRCA2

A

Tumor suppressor genes that increase a persons risk for breast and ovarian cancer

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8
Q

APC gene

A

Tumor suppressor gene that increase risk for familial adematous polyposis, which is a precursor for colorectal, esophageal, liver, lung, and ovarian cancer.

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9
Q

Carcinoma

A

Cancer composed of epithelial cells. Cover or align tissues of the body. Arises from glandular epithelium. Ex: Skin and glands. Mucous membranes of the respiratory, GI and GU tract.

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10
Q

Sarcoma

A

Cancer of supporting tissue, cartilage, bone, muscle, fat.

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11
Q

Tumor angiogenesis

A

The process of the formation of blood vessels within the tumor itself.

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12
Q

Hematogenous metastisis

A

involves several steps begining with primary tumor cells penetrating blood vessels. These tumor cells then enter the circulation, travel through the body, and adhere to and penetrate small blood vessels of distant organs. Most tumor cells do not survive this process and are destroyed.

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13
Q

Main sites of metastisis

A

Brain and CSF, Lung, Liver, Adrenals, Bone

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14
Q

Solid tumors

A

Brain, head and neck, lung, esophagus, liver, pancrease, gallbladder, small intestine, colon, rectal, uterus, cervix, ovaries, breast, skin, bone.

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15
Q

Hematologic cancers

A

Lymph, leukemia (wbc), myeloma

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16
Q

Malignant cells

A
  • Grow uncontrollably
  • Do not exibit contact inhibition
  • Poorly differentiated
  • Do not stay with their cell types
  • Have own blood supply
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17
Q

Stages of metastatic process

A
  1. Tumor growth
  2. Angiogenesis
  3. Entry into capillaries and lymph
  4. circulation to other organs
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18
Q

Factors related to carcinogenesis

A
  1. Genetic predisposition
  2. Chronic inflammation
  3. Environmental toxin exposure (radiation, tobacco, diet)
  4. Diet
  5. Regional geography
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19
Q

High fat and Low fiber diet equals

A

Increase cancer risk

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20
Q

Mediterranean Diet increases or decreases cancer risk?

A

Decreases

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21
Q

Lymphoma

A

Leukemia, hemopoetic

Cancer of lymph nodes or lymph tissue

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22
Q

Grade

A

Degree of malignancy by cells

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23
Q

Stage

A

Degree of spread

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24
Q

Blood studies for cancer

A

CBC: RBC and WBC

Tumor Markers: eg. PSA (Prostate surface antigen)

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25
Q

Cytology Exam

A

Brushing; PAP, Bronchial

Sent to lab

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26
Q

Types of Biopsies

A
Needle aspirate: Fine or Core needle
Surgical excursion of tissue sample
Frozen section vs. traditional pathology
Identifies cell type and grade
Sent to lab
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27
Q

Grade 1

A

Differs slightly from normal cells, well differeniated

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28
Q

Grade 2

A

More abnormal; moderately differentiated

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29
Q

Grade 3

A

Very abnormal, poorly differentiated

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30
Q

Grade 4

A

Undifferentiated, difficult to determine cell origin. Cells are immature and primitive.

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31
Q

Encapsulated Neoplasms

A

Usually benign; Rarely Malignant

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32
Q

Differentiated Neoplasms

A

Normally benign; Poorly malignant

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33
Q

Metastasis Neoplasms

A

Not benign; Capable of being malignant

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34
Q

Recurrence of Neoplasms

A

Rarely benign; Possibly malignant

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35
Q

Vascularity of Neoplasms

A

Benign: Slightly; Malignant: Moderate to marked

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36
Q

Mode of growth of Neoplasms

A

Benign: Expansive
Malignant: Infiltrative and expansive

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37
Q

Cell characteristics of Neoplasms

A

Benign: Fairly Normal, similar to parent cells
Malignant: cells abnormal, become more unlike parent cells

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38
Q

Stage 0

A

Cancer in situ or a neoplasm whose cells are localized and show no tendency to invade or metastasize to other tissues.

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39
Q

Stage 1

A

Tumor limited to the tissue of origin; localized tumor growth

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40
Q

Stage 2

A

limited local spread

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41
Q

Stage 3

A

Extensive local and regional spread

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42
Q

Stage 4

A

metastasis

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43
Q

TNM Classification system

A

T: Tumor size and invasiveness
N: Presence of absense of regional spread to lymph nodes
M: Metastasis to other tissues
TNM Only used with sold tumors.

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44
Q

Surgical staging

A

refers to the extent of the disease as determined by surgical ecision, exploration, and/or lympth node sampling.

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45
Q

Seven warning signs of cancer

A
CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or anywhere else
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
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46
Q

Prevention and early detection of cancer

A
Limit alcohol abuse
Get regular physical activity
Maintain a normal body weight
Obtain regular colorectal screenings
Avoid cigarette smoking and other tobacco use
Get regular mammography and Pap test
Use sunscreen SPF 15 or higher
Practice health dietary habits. Decrease Fat and increase fruit and veggie consumption
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47
Q

Fine needle aspiration biopsy

A

accomplished witha small gauge needle that provides cells from the mass for cytologic exam

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48
Q

Large core biopsy

A

Cutting needles deliver actual peice of tissue that can be analyzed with the andvantage of preserving the histologic architecture of the tissue specimen

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49
Q

Excisional biopsy

A

Surgical removal of the entire lesion, lymph node, nodule, or mass

50
Q

Goals for cancer treatment

A

Cure, Control, Palliative, Rehabilitation

51
Q

Therapy used is determined by:

A

Tumor histology and staging outcomes. Patient physiological status, psychological status, and personal desires.

52
Q

Treatment is usually multimodal use of:

A

Surgery, radiation, and/or chemotherapy.

53
Q

Control of Cancer

A

The goal for many cancers that cannot be completely eradicated, but are responsive to anticancer therapies.

54
Q

Palliation goal of cancer

A

The treatment goal when relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary objectives.

55
Q

Surgery from prevention

A

Removal of nonvital organs to prevent cancer

56
Q

Surgery for cure and/or control of cancer

A

Removal of localized cancer tissue

57
Q

Surgery for Palliative care

A

Relief of pain, obstruction, hemorrhage

58
Q

Surgery for rehabilitation

A

Reconstructive surgery

59
Q

Surgery for Supportive care

A

Insertion of therapeutic devices

60
Q

Goal of Chemotherapy

A

to eliminate or reduce the number of malignant cells in the primary tumor and metastatic tumor sites.

61
Q

Goals of Chemo

A

Cure: Burkitt’s lymphoma, Wilm’s tumor, Neuroblastoma, Acute lymphocytic leukemia, Hodgkin’s lymphoma, Testicular cancer
Control: Breast cancer, Non-Hodgkin’s lymphoma, Small cell lung cancer, ovarian cancer
Palliation: Relieve pain, Relieve obstruction, Improve sense of well being

62
Q

Chemotherapy

A

Cytotoxic agents used to destroy cancer cells.
Systemic action
Impacts cell reproduction
Cell kill theory
Affects rapidly dividing cells (Cancer and normal)
Combo therapies
WOrks best when cells are dividing

63
Q

Antimetabolites

A
Cell cycle specific chemotherapy drug 
Interfere with purine metabolism
Interfere with pyridimine metabolism
Interfere with folic acid metabolism
Interfere with DNA synthesis
Stops synthesis of cell protein
Used fo GI cancers
64
Q

Example of Antimetabolites

A

5 Flurouracil (5-FU)

65
Q

Adverse effects of Antimetabolites

A

myelosuppression, n/v, diarrhea, stomatitis, alopecia, hyperpigmentation, rash, Nadir 10-14 days, recovery 21 days

66
Q

Nadir

A

Period of time WBC lowest
Tends to be 7-14 days post chemo
More susceptible to bleeding and infection

67
Q

Plant alkaloids

A

Cell cycle specific chemotherapy drug
Vincristine (periwinkle)
Prevents mitosis
Used for leukemia, lymphoma, neuroblastoma

68
Q

Adverse effects of Plant alkaloids

A

Neurotoxicity, strong vesicant

69
Q

Taxanes

A

Cell cycle specific chemotherapy drug
paclitaxel (Taxol) (pacific yew)
Second line treatment for ovarian and breast cancer

70
Q

Adverse effects of Taxanes

A

n/v, alopecia, joint pain, myelosuppression, hypersensitivity

71
Q

Cell cycle non-specific Chemotherapy drugs

A

More toxic
Acts on cells during proliferative and non-proliferative phases.
No differentiation from normal cells.

72
Q

Alkalating agents

A

Cell cycle non-specific Chemotherapy drug
cyclophosphamide (Cytoxan) most common
Adverse effect: Severe myelosuppression, hemorrhagic cystitis, SIADH, cardiomyopathy, sterility, alopecia, n/v, anorexia

73
Q

Nitrosureas - carmustine

A

Cell cycle non-specific Chemotherapy drug

74
Q

Antibiotics - doxorubicins (Adriamycin)

A

Cell cycle non-specific Chemotherapy drugs

Adverse effects: n/v, myelosuppression, mucositis, alopecia, cardiotoxicity, strong vesicant.

75
Q

Methods of administration of chemotherapy

A

Oral, Intramuscular, Intravenous, Intracavitary, Intrathecal, intraarterial, Perfusion, continuous infusion, Subcut, Topical

76
Q

Chemotherapy agents on normal cells

A

Cannot distinguish between normal and cancerous cells.
Particularly effect rapidly proliferating normal cells such as: bone marrow, lining of GI, and integumentary system (Skin, hair, nails)

77
Q

Radiation Therapy

A

Mechanism of action: ionizing radiation destroys cells ability to reproduce. Rapidly dividing cells are more vulnerable (Skin, hair, RBC’s, GI tract lining, cancer cells.
Chain of chemical events results in formation of oxygen-free radicals that interact with surrounding cells to destroy them.

78
Q

Radiation

A

energy that is emitted from a source through space or some material. Delivery of high energy beams, when absorbed into the tissue, produces ionization of atomic particles. The energy in ionization acts to break the chemical bonds in DNA. The DNA is damaged, resulting in cell death.

79
Q

External beam radiation

A

Outside source of radiation beam accelerator
Skin area is marked
Repeated doses 5 days/wk X several weeks depends on size, location and type of tumor

80
Q

Complications of external beam radiation

A

Dry desquamation - Skin looks sunburned
Wet desquamation - occurs when the rate of cell sloughing is faster than the ability of the new epithelial cells to replace dead cells. Generally produces pain, drainage, and increased risk for infection
Fatigue

81
Q

Brachytherapy Radiation or Internal radiation

A

Radiation that is delivered close to tumor or internally.
Seeds or Rods
Allows for direct deliver of radiation to the target with minimal exposure to surrounding healthy tissues.

82
Q

Seeds or Rods

A

Placed into tumor or surrounding tumor area

Short term or permanently placed (eg Prostate seeds - left in and stop giving off radiation after weeks/months)

83
Q

Liquid radiation

A

A liquid that is drunk. Systemic into circulation. (Unsealed)

84
Q

Sealed radiation

A

Encased in nonradioactive covering - intracavity (Prostate)
Can be placed inracavity or interstitial but can contaminate if it comes in contact with skin. (eg. removable vaginal implant; emits small amount of radiation in the short term)

85
Q

Unsealed radiation

A

Secretions are radioactive - circulate through the entire body.
EX: Thyroid - drink iodine. Emisis is radioactive.

86
Q

Radiation Safety

A

Time, Distance, and shielding are vital to a ahealth care provider caring for a patient with a source of internal radiation.

87
Q

Unsealed Radiation safety and patient centered teaching

A

Active for 2-3 days after receiving
Protection from body fluids: wears off after a few days
Drink extra fluids to flush out of body
Avoid sexual contact for 2-3 days
Limit contact with infants, children and pregnant women
Wash hands after using toilet
Double flush toilet
Use separate bathroom, towels, utensils
Don’t sleep/sit right next to person immediately after receiving.

88
Q

Nursing management of a patient receiving radiation

A

Throrough assessment to ensure safety, quality care
Unsealed and Sealed Internal in Hospital:
- Private room and bath
-Diversional avtivities, communication
- Floor covering, disposable food trays
- Limit exposure
- Track caretakers/time spent

89
Q

Antiestrogens - Tamoxifen

A

First line treatment for breast cancer in post-menopausal women.
May have menopausal symptoms: Hot flashes

90
Q

Adrenocorticosteroids

A

May have palliative affects

Ex: Decrease inflammation, improve appetite, increase sense of well-being (prednisone, decadron)

91
Q

Biotherapy

A

Interferon

Biologic modifiers

92
Q

Monocolonal antibodies

A

Antibodies against specific antigens on cell surfaces

Eg: Herpicept for breast cancer; Avastin used in lung cancer

93
Q

Clinical Trials

A

Phase 1: Testing volunteers with advanced disease with no other treatment options to determine safety, kinetics, and interactions
Phase 2: Based on phase 1 info. Also tests volunteers with advanced disease for refinement of dose range, kinetics, and effectiveness
Phase 3: If drug holds promise testing of drug on larger scale for efficacy. Last step before FDA application
Phase 4: Post market surveillance after FDA approval

94
Q

Myelosuppression

A

Decreased RBC
Decreased WBC
Decreased Platelets

95
Q

Neutropenic precautions and interventions for Absolute Neutrophil Count <1000 mm3

A

Avoid crowds
Stay away from sick people
Stay away from people who have had immunizations for smallpox and chicken pox
Protect skin against breakdown
Check rectal, oral, eyes, nose, genital, PICC line for redness
Notify if chills, sweating, loose stools, fever (low grade), mouth breakdown, abd pain, vaginal itching, discharge
Report temp of 100.4 or greater; considered onco emergency
Notify if cough, sore throat, UTI
Use good hand washing, oral cleaning, good rest, some activity, NO fresh cut flowers.

96
Q

Thrombocytopenic precautions and interventions for platelets <20,000

A
Care with flossing
Blow nose gently
Avoid contact sports
Drink increased fluids
Avoid household injures
Electric Razors
Check joints for bleeding
report dizziness; change in LOC
Soft toothbrush
Check for bleeding gums, bruising, h/a, black stools, petechae.
Avoid aspirin, NSAIDS
Patient at increased risk for hemorrhage. Recover 2-6 weeks after chemo. May give platelet transfusion.
97
Q

Anemia

A

Side effect of cancer treatment due to abnomal destruction of RBC

98
Q

Nursing mamagement of Upper GI effects

A
Anti-emetic pre, during and post chemo
Avoid favorite foods during chemo time
Relaxation, hypnosis, guided imagery, meditation
Small meals
Avoid strong odors
Drink fluids separate from solid foods
Low fat foods
Oral care
99
Q

Anorexia recommendations

A
Fluids after food
Eat with family/friends
Meals on wheels
Loose fitting clothes
Ice cubes/mints/tart candies (if no open sores) to stimulate saliva
Cool, clear fluids; avoid carbonations
Increase protein
Oral care
100
Q

Refer individual for nutritional counceling as soon as ____% weight loss is noted or if the patient has the potential for protein and calorie malnutrition

A

5

101
Q

Teach the patient to use nutritional supplements in place of milk while cooking or baking. Foods to which nutritional supplements can be easily added incude

A

scrambled eggs, pudding, custard, mashed potatoes, cereal, and cream sauces.

102
Q

Superior Vena Cava Syndrome

A

Oncologic emergency
Results from the obstruction of the superior vena cava by a tumor or thrombosis
S&S: Facial edema, periorbital edema, distention of veins of the head, neck, and chest, headache and seizures.
Most common causes are lung cancer, non-hodgkins lymphoma, and metastatic breast cancer.
At increased risk if presence of a central venous catheter and previous radiation therapy to the mediastinum.

103
Q

Spinal Cord compression

A

a neurologic emergency caused by a malignant tumor in the epidural space of the spinal cord. The most common cancers that cause this are breast, lung, prostate, GI, and renal tumors and melanomas.
S&S: Severe back pain, localized and persistant, accompanied by vertebral tenderness and aggrevated by the valsalva maneuver; motor weakness and dysfunction; sensory paresthesia and loss, and autonomic dysfunction. Change in bowel or bladder function.

104
Q

Third Space Syndrome

A

Involves a shifting of fluid from the vascular space into the interstitial space that generally occurs secondary to extensive surgical procedures, biologic therapy, or septic shock.

105
Q

Nursing Management of Mucositis

A

Moth care before and after meals
Seek order for topicals
Avoid commercial alcohol based mouthwashes
Monitor mouth for redness, white lesions, dry mouth, low grade fever, difficulty swallowing
Artificial saliva
Push non-carb fluids, sugarless gum, moisten all foods with butter, gravy, sauce; soft foods
Critical to monitor- may preclude a patient from receiving next chemo and/or radiation treatment
Chapstick

106
Q

Alopecia

A

Side effect of some drugs
Begins in 2-3 weeks after 1st dose
New hair growth begins 4-6 weeks after last done
May lose eyebrows, lashes, other hair throughout the body
Hair may grow back with a different texture

107
Q

Skin Reactions

A

Erythema, uticaria, hyperpigmentation, photosensitivity, radiation recall (with chemo, post RT)

108
Q

Reproductive changes

A

Sterility, pre-Rx sperm banking, use of birth control

109
Q

Body image changes

A

Hair loss, weight loss, mastectomy, limb loss, laryngectomy, urinary or fecal diversion or incontinence, erectile dysfunction, skin changes

110
Q

Fatigue

A

Neuro-immune factors, not well understood

111
Q

Pain

A

Goal: Maximize pain relief, minimize adverse effects. Not all cancer patients have pain

112
Q

Coping

A

Fear, Loss, Change

113
Q

Treatment of fatigue

A

Evidence of highest level supports benefit of exercise in management of fatigue during the following treatment for patients with breast cancer and solid tumors.
Likely to be effective: Screening for other causes, energy conservation and activity management, education, optimize sleep quality, relaxation, massage.

114
Q

Hypercalemia - Oncologic Emergency

A

Occurs in metastatic disease of bone or multiple myeloma, or when the parathyroid hormone like substance is secreted by cancer cells.
High due to increased bone reabsorption of calcium

115
Q

Tumor lysis syndrome

A

A metabolic complication characterized by rapid release of intracellular components in response to chemotherapy.
Labs show high K, Phosphate, Uric acid levels.

116
Q

Sepsis

A

Indicator is a high temp

Nurses must be diligent in recognizing signs of infection

117
Q

Disseminated intravascular coagulation

A

Abnormal clotting of small Blood Vessels

118
Q

Syndrome of Inappropriate ADH secretion

A

Can be caused by drugs or tumor
Abnormal production of ADH
Increased sodium level and Increased fluid retention

119
Q

Hospice

A
Symptom relief
Treatment of client and family as a unit
Multidisciplinary approach
24 hr/day, 7 day/wk services
Focuses on end of life issues
Bereavement Follow up
120
Q

Hospice Symptom Management

A
Breathlessness
Nausea
Restlessness, Sleep deprivation
Pain
Fatigue,  Weakness
Depression
121
Q

Palliative Care

A

β€œan approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early detection and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

A multidisciplinary approach to patient care