care continuum (19%)

Question 1

aim to prevent disease before it occurs

e.g. smoking cessation, diet modification, exercise promotion, early detection through cancer screening, vaccines

Answer 1

primary prevention

Question 2

detecting & treating cancer early, when likely curable

Answer 2

secondary prevention

Question 3

describes how well a test can detect a specific disease or condition in people who actually have the disease or condition

e.g. erythrocyte sedimentation rate (ESR) - very sensitive to inflammation but does not delineate exactly where the inflammation is occuring

Answer 3

sensitivity

Question 4

how accurate a test will be in testing for one particular item

e.g. ESR is very specific for inflammationn

Answer 4

specificity

Question 5

• the chance a test will have a false reading
• can be false positive (positive result when it should actually be negative)
• can be false negative (negative result when it should actually be positive)

Answer 5

predictive value

Question 6

testing that is done to a large group of people

e.g. state-mandated testing performed on newborns after delivery

Answer 6

mass screening

Question 7

screening & early detection

testing that is done for a specific disease on patients who are at risk for developing that disease

e.g. genetic testing for presence of a tumor marker when there is family hx of genetic disease (such as cystic fibrosis)

Answer 7

selective/prescriptive screening

Question 8

checks for the presence of a specific disease

Answer 8

single screening

Question 9

looks for at least two abnormalities at one time

e.g. screening for elevated cholesterol and testing a PSA at the same time

Answer 9

multiple screening

Question 10

looking at a person over a period of time for the development of any conditions

e.g. assessing children for appropriate development w/each well-child visit

Answer 10

multiphasic screening

Question 11

• refers to the amount of new cases that are diagnosed in a given time period, typically a year
• reported as the number of cases per 100,000 individuals

Answer 11

incidence rate

Question 12

• the total number of cases that were active during any part of a given time period, typically a year
• this statistic can include those who are currently fighting the disease, those in remission, or those who have been cured

Answer 12

prevalence rate

Question 13

• refers to the number of people who have died from a particular disease during a given time period, typically a year
• reported as the number of deaths per 100,000 individuals

Answer 13

mortality/death rate

Question 14

• refers to the mortality among only those diagnosed w/a particular disease
• gives information on how deadly a certain type of cancer may be
• reported as a percentage

Answer 14

case fatality rate

Question 15

• refers to the likelihood of living at least a given length of time, usually 5-10 years after having been diagnosed w/a particular disease
• reported as a percentage

Answer 15

survival rate

Question 16

• refers to the likelihood of being diagnosed w/a particular disease in a given time period
• this time period can be stated as a set length of time, prior to given age, or at any point in an individual’s entire lifetime
• can be expressed as a percentage or as numerical odds (e.g. 12 out of 100,000)

Answer 16

absolute risk

Question 17

refers to the likelihood of being diagnosed w/a particular disease among those subject to an identified risk factor for the disease

e.g. __________________ of a person who smokes cigarettes developing lung cancer is much higher than the ____________________ of a person who does not smoke

Answer 17

relative risk

Question 18

• refers to difference in likelihood of being diagnosed w/a particular disease b/w those exposed to a risk factor & those not exposed
• essentially expresses how much of a person’s risk for a disease is d/t a particular risk factor

e.g. how much more likely is someone to develop lung cancer given that they smoke?

Answer 18

attributable risk

Question 19

• the chance of a person developing the disease throughout their lifetime
• does not take into account specific risk factors that may be present in different individuals

Answer 19

cumulative risk

Question 20

surivivorship

• considered the cancer patient
• called this from the moment of diagnosis
• a cancer ____________ is considered a ____________ their whole life, even if they have a recurrence

Answer 20

survivor

Question 21

• caregivers and family members are called this
• the patient does not have to die from cancer for there to be this

Answer 21

secondary survivor

Question 22

initial stage of the disease when a person is first diagnosed w/cancer

nrsg interventions: education (which continues throughout all stages) - on disease process, txs available, community resources available for support, importance of compliance w/tx plan

Answer 22

acute stage

Question 23

occurs after selected treatments are completed and includes the stage at which long-term therapy may occur

nrsg interventions: educating importance of continuing screening procedures to monitor for cancer recurrence

Answer 23

extended stage

Question 24

• patient is considered cancer free
• frequently monitored by a patient being cancer free for 5-years

nrsg interventions: education, expecially importance of continued compliance w/screening for cancer recurrence

Answer 24

permanent stage

Question 25

- pts/families may be resistive to info and unable to accept that a person is denying/impaired - may act stunned, immobile, or detached - may be unable to respond appropriately or remember what's said, often repeatedly asking the same questions ## Footnote first stage of Kubler Ross's stage of grief

Answer 25

denial

Question 26

- may be directed inward or outward - women, especially, blame themselves, lead to severe depression or guilt - men, commonly, may express overt hostility ## Footnote second stage of Kubler Ross's stage of grief

Answer 26

anger

Question 27

- involves if-then thinking (often directed at a deity) - pt/family may change doctors, trying to change the outcome ## Footnote third stage of Kubler Ross's stage of grief

Answer 27

bargaining

Question 28

- pt and family may feel no one understands what they are going through and is overwhelmed w/sadness - may be tearful or crying and may withdraw and asked to be left alone ## Footnote fourth stage of Kubler Ross's stage of grief

Answer 28

depression

Question 29

- represents form of resolution and often occurs outside of the medical environment after months - pts are able to accept death/dying/incapacity - families are able to resume their normal activities and lose constant preoccupation w/their loved ones - able to think of the person w/o severe pain ## Footnote final stage of Kubler Ross's stage of grief

Answer 29

acceptance

Question 30

immunohistochemistry (IHC)

Answer 30

- a technique in which tissue antigens on frozen tissue sections are identified - antigens are detected by the use of specific antibodies coupled to either fluorescent compounds or pigmented entities, allowing the pathologist to view these interactions on a fluoroscope or through a microscope - also various methods of amplifying the interactions, or enzymatically exposing masked antigens to aid in their visualization

Question 31

needle aspiration biopsy

Answer 31

- the removal of tissue fragments through the use of a needle - this approach is usually highly specific & predictive if positive, but sample size is typically too small to perform histological analysis

Question 32

flow cytometry

Answer 32

- method of analyzing populations of cells in suspension for various properties cells (i.e. tumor sample cells) are aspirated into the fluidic system of a machine (called a flow cytometer) - cells are mixed w/a fluid that places them in suspension & a unidirectional or laminar flow is created - as each cell flows past a laser sensor, photons emitted are picked up & intensified by photomultiplier tubes - data is electronically converted into either histograms or dot plots that compare characteristics of the cells in the population

Question 33

incisional biopsy

Answer 33

- surgical removal of only a small portion of the tumor - this approach provides more information but requires meticulous technique to avoid sampling mistakes & the induction of tumor spread

Question 34

excisional biopsy

Answer 34

- complete excision of a suspected tumor area - used for relatively small tumors or when other methods are inconclusive

Question 35

needle core biopsy

Answer 35

using a special needle to excise & retrieve a section of tissue large enough for histological analysis

Question 36

PCR molecular diagnostic technique

Answer 36

- amplifies the amount of DNA, which is usually then used in other methodologies, such as sequencing - an enzyme called reverse transcriptase is used to generate DNA copies called cDNA from an RNA template w/short nucleotide chains or oligonucleotides as primers - number of cDNA copies is then usually amplified through a process called nesting

Question 37

southern blotting molecular diagnostic technique

Answer 37

- uses enzymatic digestion of a pt sample, electrophorectic separation of the products, then probing or blotting w/suitable molecular probes - latter methodology is labor intensive & slow

Question 38

tumor marker assays

Answer 38

- quantify levels of certain molecules found in serum, other body fluids, cells, & tissues that have an association w/the presence of malignancy - most of the available assays are either radioimmunoassays (RIAs) or enzyme-linked immunosorbent assays (ELISAs), which respectively use radioisotopes or enzymes linked to various substances (often specific antibodies) as detection vehicles - value of these immunoassays depends upon their specificity (i.e. their ability to accurately detect malignancy vs. normal tissue or benign growths) & sensitivity (the capacity for early detection during screening or preliminary Dx)

Question 39

health disparities

Answer 39

describes the concept of a disease or class of diseases having a measurably different impact on different subsets of a population, usually applied to distinct ethnic groups

Question 40

how does smoking impact the development of lung cancer?

Answer 40

- approx. 90% of all people who develop lung cancer are smokers - there are known risks for lung cancer w/second-hand exposure to smoke, but no exact figures are known for incidence of cancer in this population - it is known when smokers quit smoking, some repair occurs within lung tissue - this does not immediately decrease the risk of developing lung cancer, but the risk will begin to decrease at least 5 years after quitting smoking

Question 41

what does the CDC recommend to prevent cancer from human papillomavirus (HPV)?

Answer 41

- approx. 26,000 cases of cancer diagnosed each year are directly attributable to HPV - CDC recommends an **HPV vaccine** for females 13-26 years of age & for males 13-21 years of age

Question 42

Americans with Disabilities Act (ADA) & Federal Rehabilitation Act

Answer 42

federal laws that prohibit employers from discriminating against their employees based on a disease or disability

Question 43

Genetic Information Nondiscrimination Act (GINA)

Answer 43

* provides protection from discrimination of employees based on the results of a genetic test or a family hx of a disease * the ________________ law covers the same employers that are covered under the ADA law (those w/at least 15 employees)

Question 44

Family & Medical Leave Act (FMLA)

Answer 44

requires employers of at least 50 or more employees to provide up to 12 wks of unpaid leave during any 12-month period to attend to their own serious health conditions or that of an immediate family member

Question 45

rehabilitation

Answer 45

aim of ________________ is the cure of the patient, or as near to that as possible, w/the reinsertion of the patient back into his or her original environment w/the same job, duties, & interpersonal relationships the patient had before the cancer Dx

Question 46

adaptation

Answer 46

* ____________ of the patient is a consequence of tx, w/all limitations acknowledged & overcome to the fullest extent possible w/o compromiosing the patient's quality of life that was present before * goal is to reenter life as before or as near to previous life as possible * there are many organizations that can give support & comfort, & ease the transition back into normal life

Question 47

reintegration

Answer 47

* describes the process of assisting the patient to return to work through a program w/their employers to understand each other's needs & how to work together to reach the goal or re-employment