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OCN Review > Quality of Life Issues > Flashcards

Quality of Life Issues Flashcards

1
Q

Name 7 Factors that may influence any patient’s Fertility or sexual health with Cancer Treatment?

A
  1. Baseline fertility/sexual health
  2. Age at the time of treatment
  3. Type of cancer and treatment(s)
  4. Treatment dose
  5. Treatment (duration) 6. Elapsed time since treatment
  6. Other personal health factors
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2
Q

When is the Best Time to learn how cancer treatment may affect fertility?

A

Before starting treatment

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3
Q

What are 6 ways Cancer treatment can affect Male Fertility?

A
  1. Chemotherapy (especially alkylating drugs) can damage sperm and sperm-forming cells (germ cells)
  2. Hormone therapy (also called endocrine therapy) can decrease the production of sperm.
  3. Radiation therapy
    * RT to reproductive organs and near the abdomen, pelvis, or spine may lower sperm counts and testosterone levels, causing infertility.
    * RT may also destroy sperm cells and the stem cells that make sperm.
    * RT to the brain can damage the pituitary gland and decrease the production of testosterone and sperm.
  4. Surgery for cancers of the reproductive organs and for pelvic cancers (such as bladder, colon, prostate, and rectal cancer) can damage these organs and/or nearby nerves or lymph nodes in the pelvis, leading to infertility.
  5. Stem cell transplants such as bone marrow transplants and peripheral blood stem cell transplants, involve receiving high doses of chemotherapy and/or radiation. These treatments can damage sperm and sperm-forming cells.
  6. Other treatments: such as immunotherapy and targeted cancer therapy, may also affect fertility
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4
Q

What is one method of protecting Fertility in Males undergoing RT?

A

Testicular shielding: For some types of cancers, the testicles can be protected from radiation through Testicular shielding.

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5
Q

True or False:

For patients infertility can be one of the most difficult and upsetting long-term effects of cancer treatment.

A

True

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6
Q

True or False:

Most people benefit from having talked with the doctor about how treatment may affect fertility and learning options to preserve fertility.

A

True

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7
Q

Describe Male fertility preserving options.

A
  1. Sperm banking
  2. Testicular shielding (also called gonadal shielding)
  3. Testicular sperm extraction (TESE) is a procedure for males who are not able to produce a semen sample.
  4. Testicular tissue freezing (also called testicular tissue cryopreservation) is still considered an experimental procedure at most hospitals. For boys who have not gone through puberty and are at high risk of infertility, this procedure may be an option.
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8
Q

List 6 ways Cancer treatments can disrupt Male Sexual health?

A
  1. Chemotherapy
    * May lower testosterone levels
    * May decrease libido
    * Need for condom use to protect partner from traces of chemotherapy in semen or from pregnancy
  2. Radiation including External-beam radiation therapy or brachytherapy (also called internal radiation therapy) to the pelvis (such as to the anus, bladder, penis, or prostate)
    * Can cause erectile dysfunction if vessels or nerves are damaged
    * If the prostate is damaged, may cause dry orgasm.
  3. Hormone therapy can:
    * lower testosterone levels and decrease a man’s sexual drive.
    * Make it difficult to get or keep an erection.
  4. Surgery for penile, rectal, prostate, testicular, and other pelvic cancers may affect the nerves, making it difficult to get and keep an erection.
    * Sometimes nerve-sparing surgery can be used to prevent these problems.
  5. Medicines used to treat pain, some drugs used for depression, as well as medicines that affect the nerves and blood vessels may all affect libido
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9
Q

List 4 ways to assist Male oncology patients with Sexual Health

A
  1. Discuss treatment options when sexual health problems arise
    * Meds such as viagra (enable an erection)
    * penile implants (sustain an erection)
  2. Discuss condoms and contraception that may be required for Male partner safety (protect from chemotherapy in semen) and to prevent pregnancy if partner is a of WOCBP.
  3. Manage treatment side effects that my affect sex and libido
    such as: pain, fatigue, hair loss, depression, insomnia
  4. Connect patients with support and counseling
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10
Q

What are 6 Ways cancer treatment can affect Female fertility

A
  1. Chemotherapy (especially alkylating agents) can cause:
    * Primary ovarian insufficiency (POI)
    * hot flashes, night sweats, irritability, vaginal dryness, and irregular or no menstrual periods.
    * lower the number of healthy eggs in the ovaries.
  2. Radiation therapy:
    * to or near the abdomen, pelvis, or spine can harm nearby reproductive organs.
    * to the brain can also harm the pituitary gland (which may disrupt estrogen levels needed for ovulation.
  3. Surgery for cancers of the reproductive system and for cancers in the pelvis region can harm nearby reproductive tissues, nerves, or vessels
  4. Hormone therapy (also called endocrine therapy) can disrupt the menstrual cycle, which may affect your fertility.
  5. Bone marrow transplants, peripheral blood stem cell transplants, and other stem cell transplants involve receiving high doses of chemotherapy and/or radiation. These treatments can damage the ovaries and may cause infertility.
  6. Other treatments: such as immunotherapy and targeted cancer therapy, may also affect fertility
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11
Q

What is primary ovarian insufficiency (POI).

A

primary ovarian insufficiency (POI). is when the ovaries stop releasing eggs and estrogen.

Chemotherapy can cause POI

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12
Q

What are two ways ovaries can be protected during RT?

A
  1. ovarian shielding
  2. oophoropexy—a procedure that surgically moves the ovaries away from the radiation area.
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13
Q

What are Fertility preservation options for Females?

A
  1. Egg freezing (also called egg or oocyte cryopreservation)
  2. Embryo freezing (also called embryo banking or embryo cryopreservation)
  3. Ovarian tissue freezing (also called ovarian tissue cryopreservation) is still experimental, for young girls who haven’t gone through puberty and don’t have mature eggs.
  4. Ovarian transposition (also called oophoropexy) is an operation to move the ovaries away from the part of the body receiving radiation.
  5. Radical trachelectomy (also called radical cervicectomy) is surgery used to treat women with early-stage cervical cancer who would like to have children.
  6. Treatment with gonadotropin-releasing hormone agonist (also called GnRHa) to protect the ovaries by causing the ovaries to stop making estrogen and progesterone. Research is ongoing regarding effectiveness of GnRHa to protect the ovaries.
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14
Q

List 5 ways Cancer treatments can disrupt Female Sexual health?

A
  1. Chemotherapy
    * Can lower estrogen levels and cause POI, ovaries my stop releasing eggs causing symptoms of hot flashes, amenorrhea or irregular periods, vaginal dryness (intercourse difficulty or pain).
    * Can affect vaginal tissue, which may cause sores.
  2. Hormone (endocrine therapy) may cause
    * low estrogen levels symptoms described in #1 above
    * other less common side effects such as: blood clots, stroke, cataracts, endometrial cancer and uterine sarcoma, bone loss, mood swings, depression, and loss of libido
  3. Radiation therapy to the pelvis can cause:
    * low estrogen levels and, therefore, vaginal dryness
    * Vaginal stenosis
    * Vaginal atrophy
    * Vaginal inflammation (itching, burning)

4 Surgery:
* For gynecologic cancers may affect sexual life.
* For other cancers can cause physical changes that may affect body image (ie. mastectomy, ostomy).

  1. Medicines such as opioids and some drugs used to treat depression may lower libido
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15
Q

List 4 ways to assist Female oncology patients with Sexual Health

A
  1. Discuss treatment options when sexual health problems arise
    * vaginal gels or creams to stop a dry, itchy, or burning feeling
    * vaginal lubricants or moisturizers
    * vaginal estrogen cream that may be appropriate for some types of cancer
    * a dilator to help prevent or reverse scarring
    *Exercises for pelvic muscles to lower pain, improve bladder retention, improve bowel function, and increase the flow of blood to the area, which can improve your sexual health
  2. Manage treatment side effects that may affect sex and libido - such as: pain, fatigue, hair loss, depression, insomnia
  3. Discuss condoms and contraception that may be required for partner safety (protect from chemotherapy in vaginal secretions) and to prevent pregnancy during and after treatment.
  4. Connect patients with support and counseling
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16
Q

Name 3 reasons why performing a Sexual Health assessment can be helpful.

A
  1. Give patient permission to mention sexual difficulties
  2. Gives RN permission to ask questions when a sexual side effect may be suspected
  3. Lessens embarrassment and normalizes the discussion
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17
Q

Name 7 barriers to RNs performing Sexual Health assessments

A
  1. Embarrassment
  2. Lack of education/knowledge of the nursing interventions for discussed problems
  3. Fear of legal consequences
  4. Feeling invasion of privacy
  5. Thinking patient does not expect RN to ask
  6. Thinking another clinician will address
  7. Thinking sexuality is not an issue (because of patient age, stage of cancer, seriousness of the disease)
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18
Q

Name 2 Models for Sexual Heath assessments

A
  1. PLISSIT Model
    * P: Permission - RNs give patient permission to discuss
    * LI: Limited information - RN can provide patients with info. specific to their condition or treatment plan
    * SS: Specific suggestions - based on patient concern
    * IT: Intensive therapy - referral when indicated
  2. BETTER Model:
    * B - Bring up the topic
    * E - Explain sexuality as a part of QoL
    * T - Tell patients about resources
    * T - Timing
    * E - Educate about side effects
    * R - Record in EMR
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19
Q

Name 6 contributing factors to Sexual dysfunction

A
  1. Type of cancer
  2. Treatment effects
  3. Body altering treatments (ie ostomies, surgeries to: head and neck, gynecologic, urologic, and prostate areas)
  4. Stress and emotional distress in patients and their partner
  5. Body image changes, such as a patient’s view of self as male or female
  6. Reproductive issues
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20
Q

What are Sexual Dysfunction: Management Strategies that Nurses can provide (8 listed)?

A
  1. Conduct a sexual history
  2. Provide education in basic physiologic function and ways that treatment may affect
    function. Do not assume patients know basic sexuality information
  3. Encourage communication
  4. Incorporate patients’ value system and cultural beliefs into interventions.
  5. Encourage patients to speak to the physician or surgeon
    regarding preserving sexual function
  6. Help patients expand sexual options (ie massage, fantasy, change in position, or sexy lingerie to cover altered body sites)
  7. Consider the use of vaginal moisturizers and water-based lubricants
  8. Facilitate referrals (medical interventions, psychosocial support, sexual counselor).
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21
Q

What is Psychosocial Distress?

When can psychosocial distress be experienced by an onocolgy patient, and name 4 associated issues.

A

Psychosocial Distress refers to the unpleasant emotions or psychological symptoms an individual has when they are overwhelmed, which negatively impacts their quality of life (and cancer care).

Distress can occur anytime during the cancer experience and is associated with:
1. depression
2. anxiety
3. missed appointments
4. Less adherent to treatment plans
5. more dissatisfied with overall care
6. experience poorer quality of life
7. have poorer survival rates and adverse outcomes

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22
Q

What are two psychosocial assessment tools?

A
  1. Distress Thermomenter (DT) - paper assessment
  2. ESRA-C (Electronic Self-Report
    Assessment–Cancer)
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23
Q

What do NCCN guidelines state about Psychosocial Distress in the oncology patient?

A

The NCCN Distress
Guidelines state that “distress should be recognized, monitored, documented, and treated promptly at all stages of the disease and in all settings”

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24
Q

What is the American College of Surgeons CoC?

What does CoC standard 3.2 address?

A

American College of Surgeons Commission on Cancer® (CoC) is a consortium of 47 professional organizations, including ONS.

The CoC has an Accreditation
Committee (physician and nonphysician members) who set standards for accreditation of facilities that provide cancer care.

As part of accreditation, CoC Standard 3.2 “develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care”

CoC recommends screening for psychosocial concerns at least once per patient at a “pivotal” medical visit (ie diagnosis, treatment change, progression)

25
Q

What is the Distress Thermometer (DT)?

A

The Distress Thermometer (DT) is one psychosocial assessment tool (paper) that patients can complete in less than 5 min. The tool contains two components:

  1. a visual scale (thermometer) ranging from
    * 0 (no distress) to
    * 10 (extreme distress)
  2. Yes-or-no items (38 questions) to five categories of concerns:
    1. practical (child care, housing, transportation, insurance, work/school, treatment decision)
    2. family (dealing with children, partner, ability to have children, family health issues)
    3. emotional (depression, fears, anxiety)
    4. spiritual/religious
    5. physical problems (appearance, breathing, self-care, bowel/bladder issues, appetite, memory/concentration, pain, sleep, etc.)
26
Q

What is The Electronic Self-Report
Assessment–Cancer (ESRA-C)?

A

The Electronic Self-Report Assessment–Cancer (ESRA-C) is one psychosocial assessment tool completed by the patient electronically. The ESRA-C tool assesses patient-reported cancer symptoms and quality-of-life issues.

The ESRA-C tool includes embedded, reliable measures of depression
and emotional functioning.

27
Q

What did the first clinical trial using the ESRA-C psychosocial assessment tool demonstrate regarding psychosocial concerns?

A

The first clinical trial using the ESRA-C psychosocial assessment tool demonstrated

Psychosocial concerns were addressed significantly more often when providers received a summary report of symptoms and quality-of-life issues prior to a visit

28
Q

What is the Estimated Prevalence of Psychosocial Distress in oncology patients (what % of patients are estimated to experience Psychosocial distress)?

What is the estimated % of patients identified as needing intervention (and referred for help)?

A

An estimated 20%–40% of oncology patients experience psychosocial complications according to the NCCN.

Less than 10% of oncology patients are actually identified as needing intervention and referred for help.

29
Q

What are 6 common Psychosocial needs identified by oncology patients and families?

A

Psychosocial Distress can manifest in numerous ways. Oncology patients and families have identified the following needs:

  1. Cultural and Spiritual
  2. Body image and sexuality
  3. Anxiety
  4. Depression
  5. Cognitive dysfunction
  6. Sleep-wake disturbances
30
Q

Define cancer Survivorship.

A

Cancer survivorship encompasses the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life (Thom et al., 2018). Its defnition includes the health and life of a person with cancer beyond the diagnosis and treatment phases.

31
Q

What is an Advance directive?

What are the two most common types of advance directives?

A

Legal document that states a patient’s wishes regarding medical decisions. May also give specific details about death preferences.

The two most common types of advance directives are:
1) Living will
2) Durable Power of Attorney (healthcare proxy)

32
Q

What is a Living Will?
What are requirements to activate?
What does it specify?

A

A legal document designed to control specific future healthcare decisions when an
individual is unable to make decisions.

The individual must:
1) Have a terminal diagnosis
OR
2) Be in a persistent vegetative state

Describes specifc types of treatment (ie dialysis, feeding tube, or ventilators) & organ donation preference.

33
Q

What is A Durable Power of Attorney?

Who typically cannot be a DPOA?

What do most states require for DPOA appointment?

A

An individual who has been appointed as the patient’s proxy to make healthcare decisions if the patient is unable to make those
decisions.

  • A proxy cannot be a physician, nurse, or other person providing healthcare services to the patient, unless the person is a close relative.
  • States with laws that allow appointment of a DPOA usually require signed by the patient and the appointed proxy.
34
Q

Do Advance directives affect financial or money matters?

A

No. Advance directives only apply to health care decisions and do NOT affect financial or money matters.

35
Q

True or False:
Health care facilities can require patients to have advance directives.

A

False.
Health care facilities CANNOT require patients to have advance directives: It is the patient’s choice.

36
Q

What is the Patient Self-Determination Act (PSDA)?

What are 4 requirements for Health care facilities?

A

Encourages patients to make decisions in advance about the types and extent of medical care they desire/refuse (when incapacitated)

Requires Health care facilities:
1) To give patients information about their rights to make decisions about their care.
2) To find out if patients have an advance directive.
3) To recognize and honor advance directives
4) To never discriminate against patients based on whether they have filled out an advance directive or not.

37
Q

What is Palliative Care?

What is the goal?

A

Palliative Care is care for those living with a chronic or serious illness focused on providing relief from the symptoms and stress of a serious illness.

The goal of Palliative Care is to improve Quality of Life for patients and their family by:
1) Treating symptoms of disease
2) Treating side effects of treatment
3) Addressing psychological, social, and spiritual challenges

38
Q

What is hospice?

Is it a form of Palliative Care?

What kind of care intent?

A

Hospice provides care to individuals who have a limited life expectancy (i.e., prognosis of six months or less).

Yes, hospice is a form of palliative care.

Focuses on caring without curative intent.

39
Q

What does some evidence suggest regarding life expectancy of patients connected with palliative care services vs. those who are not?

A

Some evidence suggests that, on average, palliative care and hospice patients may live longer than similarly ill patients who do not receive such care

40
Q

What is the duration of palliative care from the position of ONS?

A

Palliative care begins at the time of diagnosis and continues throughout bereavement

41
Q

What 9 entities can define the palliative care team?

A
  1. Patient
  2. Family member(s)
  3. Palliative care physician
  4. Nurse practitioner
  5. Nurses
  6. Social worker
  7. Nutritionist
  8. Pharmacist
  9. Occupational and physical therapist
42
Q

What are the approximate prevalence (%) of symptoms affecting patients with
advanced cancer?

A
  • Pain, 89%
  • Fatigue, 69%
  • Weakness, 66%
  • Anorexia, 66%
  • Nausea, 60%
  • Dry mouth, 57%
  • Constipation, 52%
  • Early satiety, 51%
  • Dyspnea, 44%
  • Vomiting, 30%
43
Q

List 5 Nonpharmacologic Complementary and Alternative medicine (CAM) interventions for Comfort.

List 7 Additional Nonpharmacologic comfort measures.

A
  1. Aromatherapy
  2. Massage
  3. Music therapy
  4. Acupuncture
  5. Prayer and meditation

Additional:
1. Dyspnea; Directing a fan at a low speed toward the face
2. Photosensitivity: Altering lighting
3. Guided imagery
4. Positioning
5. Bathing
6. Simple touch
7. Being present

44
Q

Cancer is the #_____ most common cause of death in the US?

Cancer causes nearly 1 every in #_____ deaths in the US?

A

Cancer remains the second most common cause of death in the United States.

Cancer causes nearly one of every four deaths.

45
Q

Name 4 end-of-life care needs.

A
  1. Physical care
  2. Intellectual and emotional care
  3. Social support (including family, friends, and caregivers)
  4. Referral to resources (psychosocial, financial, and spiritual)
46
Q

Define hospice in terms of:
1. Team
2. Who is supported
2. When
3. Focus

A
  1. Interdisciplinary care
  2. Patients and families
  3. when a patient has an illness for which the prognosis is expected to be six months or less
  4. focus of care is on comfort-oriented approaches.
47
Q

What is Grief?

Is grief manifested only emotionally?

What are 7 possible signs?

A

Grief is a personal experience in response to the loss of something or someone valued or loved through death.

No. Grief can be manifested emotionally or physically.

Grief signs/symptoms include:
1. Sadness
2. Shock
3. Guilt
4. Sleep–wake disturbances
5. Confusion
6. Tightness in chest, feelings of panic
7. Social withdrawal or hostility

48
Q

What is Mourning?

Does Mourning have a defined period of time?

What are 4 common Mourning practices following death?

A

Mourning is a public display of Grief, the process of coping with loss and grief.

No. Mourning has no time limit, it is individualized.

  1. Wakes,
  2. Funerals
  3. Memorials
  4. Family or religious rituals
49
Q

What is Anticipatory Grief?

Can it be more intense than the Grief experienced immediately after death?

What are 5 common characteristics?

A

Anticipatory grief is Grief experienced before the impending loss of the loved one.

Includes not only loss of a loved one, but also to all other losses related to the illness, confinement, and changes in life that have occurred.

5 Characteristics:
1, Preoccupation with the person who is dying
2. Loneliness and fear
3. Irritability and anger
4. Tearfulness and lability
5. Cognitive dysfunction

50
Q

What #______ out of 5 grieving individuals experiences Major Depression?

What are 3 risk factors for developing Major Depression?

What are 6 symptoms of Major Depression?

A

One in five grieving individuals develop major depression and should be referred for treatment.

Major Depression risk factors include:
1. few support systems
2. drug or alcohol abuse history
3. Other major life stressors

Major Depression Symptoms may include:
1. Hopeless, helpless
2. intense guilt
3. Inability to perform ADLs
4. Thoughts of suicide
5. Significant weight loss
6. Hallucinations or delusions

51
Q

What is Complicated Grief?

What are 7 characteristics of Complicated Grief?

A

Complicated grief refers to a lack of normal mourning or an extended mourning period that does not lesson in intensity with time; can also include elevated distress and disability caused by these reactions and their persistence and pervasiveness.

Complicated Grief characteristics;
1. Continual disbelief that the loved one is truly gone
2. Inability to accept the reality oF the death
3. Prolonged symptoms oF sadness, crying, and depression
4. Flashbacks or nightmares
5. Ongoing yearning for the lost individual
6. Social isolation
7. Maintaining fantasy presence of the deceased; referring to the deceased as being present

52
Q

What marks “normal” or common Grief?

What are 4 “normal” or common grief reactions?

A

“Normal” or common Grief is marked by a gradual movement toward an acceptance of the loss

“Normal” or common Grif reactions:
1. Numbness and disbelief.

  1. Separation distress (yearning-anger-anxiety).
  2. Depression-mourning.
    Or Disorganization-despair.
  3. Eventual recovery (largely resolve within 1-2 years). Or Reorganization.
53
Q

What is the estimated % of patients with incurable cancer that experience anticipatory grief?

A

Not all patients are estimated to experience anticipatory grief:

Estimated at 25%.

54
Q

Is Anticipatory Grief the same as conventional grief -> only starting earlier?

A

No.

55
Q

Can a patient experience Anticipatory Grief or only Depression?

A

Yes, a patient can experience Anticipatory Grief.

Anticipatory grief and depression can be assessed and treated as separate mental health issues by using measures specifically developed for anticipatory grief.

56
Q

Primary grief indicators peak at ~how much time postloss?

How can knowledge of this timeline help grieving individuals?

A

Primary grief indicators peak at approximately 6 months postloss, after which the negative grief indicators begin to decline.

This suggests that individuals who are still experiencing elevated levels of grief after that time may benefit from from mental and physical health care providers.

56
Q

What are the 5 stages of grief in the most well-known Grief Model?

How has the model become reconceptualized?

A
  1. denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance.

However, this model has limited empirical support.

Later the model was reconceptualized from STAGES of grief to DOMAINS of grief where an individual may move back and forth among the domains - no predefined path or progression (implied by stages).

56
Q

Compare “normal” Grief vs. clinical major depression with the following:
1. Painful feelings
2. Prevailing affect
3. Self-esteem
4. suicidal ideation

A
  1. Painful feelings:
    GRIEF comes in waves, lessen in intensity and frequency over time, and are often intermixed with positive memories of the deceased
    DEPRESSION mood and ideation are constantly negative.
  2. Prevailing affect:
    GRIEF: emptiness;
    DEPRESSION: a long, sustained, depressed mood and an inability to expect pleasure or happiness.
  3. Self-esteem:
    GRIEF: usually preserved
    DEPRESSION: feelings of worthlessness and self-loathing are common.
  4. suicidal ideation:
    GRIEF: can occur, generally focused on the deceased, such as a wish to join the deceased in death or feelings of guilt toward certain gaps or failures in the relationship with the deceased.
    DEPRESSION: more likely directed at self only.

OCN Review (5 decks)

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