Colorectal Cancer - Treatment and Side Effects - Essay Example

? COLORECTAL CANCER April 14, Role of Fluorouracil and John’s side effect Fluorouracil is an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug.  It is classified as an antimetabolite and is administered for treatment of Colon and rectal cancer, breast cancer, gastrointestinal cancers among other forms of cancer (Center, 2009). However, in its use it exhibits various side effects such as; fatigue, nausea, poor appetite low blood counts, white, red blood cells and platelets may temporarily decrease which can put one at increased risk of infection and anemia further exacerbating fatigue. The main side effect exhibited in John in the case study is general fatigue, which may be attributed to the fluorouracil administered to him. The relationship between such side effect and fluorouracil can be accounted for by how it works in that its most effective at killing cells that are rapidly dividing (cancerous cells) (Knowles, 2007).  Unfortunately it does not know the difference between the cancerous cells and the normal cells and thus normal cells are adversely affected. Although the normal cells will grow back and be healthy in the meantime side effect in which case fatigue occur.  The "normal" cells most commonly affected by fluorouracil are the blood cells which account for a drop in hemoglobin levels as can be said of John which dropped to 100 from the normal level of 130-180/liter of blood. Interventions to Manage side effect experienced by John Cancer-related fatigue, defined by the National Comprehensive Cancer Network (NCCN) as a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning of an individual can be described in terms of perceived energy, mental capacity, and psychological status (Choo, 2008). It arises over a continuum, ranging from tiredness to exhaustion. By contrast however with the tiredness sometimes felt by a healthy individual, cancer-related fatigue is perceived as being of greater magnitude, disproportionate to activity or exertion and not completely relieved by resting, leaving the patient with an overwhelming and sustained sense of exhaustion (Australia, 2009). Fatigue is one of the most prevalent and distressing common side-effect of many of the cancer treatments available for the management of malignant disease as John is currently experiencing. Critical Assessment of Various Interventions There are various interventions that can be used to deal with the same as here below described. Non-pharmacological interventions Education Research has documented the beneficial effects of providing patients with preparatory knowledge, including sensory information, about their disease and treatment. If patients receive valid information about what to expect, they are more likely to develop accurate expectations and are less likely to experience the stress that accompanies unforeseen problems. For example, uninformed patients often interpret fatigue to mean that their cancer treatment is not working or that their disease is progressing. With appropriate educational grounding therefore, patients can prepare for side-effects and adopt management strategies (Council N. H., 2008). Exercise In the management of fatigue, exercise is the intervention with the most supporting evidence of effectiveness. The theory supporting exercise as treatment for fatigue proposes that the combined toxic effects of cancer treatment and a decreased degree of physical activity during treatment cause a reduction in the capacity for physical performance (Australian Government, 2005). When patients must use greater effort and expend more energy to succeed in daily activities, fatigue levels increase. Exercise training leads to a reduction in the loss or even an increase in functional capacity, leading to reduced effort and decreased fatigue. All research work on effectiveness of exercise in managing cancer-related fatigue indicate significantly lower levels of fatigue in individuals who exercised than those who didn’t. Although the results have been consistent across studies, the studies are limited in number, sample sizes are mostly small, and there are methodological limitations associated with many. Nevertheless, using limited energy to do highly valued activities instead of mundane tasks that can be delegated could increase personal satisfaction and quality of life as well as manage fatigue (Nurses). Rest and sleep Patients with fatigue are often advised by health-care professionals to get additional rest and sleep. The relationship between sleep disturbance and fatigue has been inadequately investigated. Patients with cancer report significant disruptions in sleep and the essential issue may be sleep quality rather than quantity. Results of two studies, which used actigraphy to measure activity and sleep, have shown that cancer patients spend more time resting and sleeping than healthy individuals but that the pattern of sleep is often severely disrupted with awakening almost every hour. Patients who try additional rest and sleep to manage fatigue do not report it to be particularly effective. The research being done to test rest or sleep to manage fatigue is in preliminary stages, and only one abstract of a pilot project has been published (Chung, 2007). Energy conservation Energy conservation is a frequent treatment recommendation for cancer-related fatigue. Although research is limited, results of a pilot study have been published and a multicentre randomized clinical trial is in progress (Council A. H., 2008). Decreasing activity to save energy could contribute to reconditioning and decreased activity tolerance. Nevertheless, using limited energy to do highly valued activities instead of mundane tasks that can be delegated could increase personal satisfaction and quality of life as well as manage fatigue. Stress reduction Studies testing interventions to reduce stress and increase psychosocial support have also shown reductions in fatigue, usually as a component of mood state. However because these interventions did not have fatigue as a primary endpoint, fatigue measures are often limited to a subscale on an instrument to measure emotional distress, and the interventions generally did not attempt to elucidate a mediating mechanism of fatigue. Cancer-related fatigue could be a response to stress, or the emotional state of a patient could affect the way he or she perceives and reports fatigue (Welfare, National Bowel Cancer Screening Program: Annual monitoring report 2009 Data supplement 2010, 2011). Although strong correlation exists between emotional distress and fatigue the precise relation is not clearly understood. The specific interventions tested have included support groups, counseling, and a comprehensive coping strategy. In the studies of support groups, the experimental groups have shown less overall mood disturbance, less depression, less fatigue, and greater vigor than control groups on the profile of mood states scale. A comprehensive coping strategy program was tested in a randomized controlled clinical trial to see whether it could reduce pain, fatigue, nausea, and psychological distress in a hundred and ten breast-cancer patients undergoing autologous bone marrow transplantation (PE, 2006). The coping strategy program included components of preparatory information, cognitive restructuring, and relaxation with guided imagery practiced daily from baseline until seven days after transplantation. The program significantly reduced fatigue combined with nausea seven days after transplantation, but there were no significant differences in the two groups with respect to fatigue alone. Pharmacological therapy Three large community-based non-randomized studies and two double-blind randomized clinical trials have shown a clinical benefit of epoetin alfa treatment on cancer-related anemia and fatigue (Pontieri-Lewis, 2006). In these studies, erythropoietin Alfa reduced the need for transfusions, decreased fatigue levels, and improved quality of life in patients receiving chemotherapy. Published guidelines support this conclusion. The new erythropoietin agent, darbepoetin alfa, has shown similar outcomes with less frequent dosing. Few controlled studies have been done to investigate other pharmacological therapies for cancer-related fatigue combat cancer-related cachexia, megestrol acetate has been investigated in several studies and been found to alleviate anorexia and improve weight (Knowles, 2007). In another study this drug reduced fatigue to some degree in patients with advanced cancer. Based on the above analysis of possible interventions therefore the following two key interventions can be suggested to deal with John’s condition as are deemed appropriate. (Services, 2006)Intervention one: Education This is one of the key intervention that can be used to manage the cancer-related fatigue that John is experiencing in the sense that by him acquiring vital knowledge about cancer he will be able to appreciate his condition even better and help eradicate such stances as exercising in the gym is not his thing and may even observe his diet that has not changed much since he was diagnosed with the disease (T.K, 2002(Issue 1)). In implication therefore fatigue that may have been as result of not exercising well enough as required will be managed. Intervention two: Stress Reduction Secondly, reduction of stress could prove a significant method that can be used to manage the cancer-related fatigue that John is currently experiencing. By him participating actively in local ‘Men’s Shed’ that is currently busy with multiple projects to help local charities in the pretext that he enjoys it because it gives him something to concentrate on besides the cancer could in fact be the source of his fatigue. Such activities coupled by the fact that he looks after his grandchildren two days in a week could be quite demanding and stressful which consequently leads to his fatigue. To this extent therefore by significant checking his stress level then he could simply manage the fatigue (Committee, 2005). Evaluation criteria of effectiveness of the suggested interventions The above suggested interventions are the most appropriate especially in view of John’s conditions as for instance you can’t just suggest exercise while he has negative stance on the same, again rest and sleep cannot work for him because he complains of fatigue even after sleeping for nine hours (Australia, 2009). Pharmacology on the other hand may also not be an answer for him because it’s the treatment that is causing the fatigue and therefore prescribing further medication may not be the most relevant method. Here below are the ways that can be used to ascertain the effectiveness of the suggested interventions. Intervention one The most important criteria that can be used to gauge the effectiveness of the intervention in a bid to manage John’s situation is the ability of the patient to appreciate his condition and accept it as just another ailment that one can suffer from. Secondly, is the ability of John to rethink his stand with regards to exercise as well as his diet to comply with what is expected of a cancer patient. Thirdly and which is the most obvious is to ascertain if John’s complains against fatigue has reduced if not subsided after the intervention is employed. Intervention two (Stress Management) The most important criteria that can be used to gauge the effectiveness of the intervention here is the aptitude of John to reduce if not to avoid all stressful activities that he is currently engaged in and that in a way may be the source of his fatigue (Council N. H., 2008). Secondly, the underlining criteria to ascertain the effectiveness of the method employed to contain the side effect experienced by John is of course a follow up on John to find out if his complains against fatigue have reduced if not subsided in totality. Summary Although fatigue is the most prevalent symptom reported by cancer patients, the assessment and management of this distressing effect of cancer and cancer treatment has been limited. This paucity of work is related to many factors, including a lack of understanding of the mechanisms responsible for cancer-related disease, a lack of awareness by cancer-care providers of the importance of the problem, and a lack of evidence-based interventions to manage the condition. Treatment of anemia improves a patient’s fatigue levels and quality of life. However when a patient is not anemic, the most common interventions for fatigue are behavioral ones with exercise and psychosocial interventions as the most effective. Research into other management methods such as energy conservation and sleep is continuing. Nevertheless the science related to cancer-related fatigue is developing rapidly, research-based clinical practice guidelines for fatigue management are now available and awareness by health-care professionals of the importance of this disruptive symptom is greater than ever before. References Australia, C. C. (2009). National cancer prevention policy 2007-2009. 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