Radiotherapy in Cancer Care - Essay Example

RADIOTHERAPY IN CANCER CARE Grade: Table of Contents Table of Contents 2 Background 3 Rationale of choice 3 Literature review 4 Introduction 4 Action of Radiotherapy 4 Occurrence of Fatigue 5 Factors That Influence the occurrence of Fatigue 6 Critical Analysis on Management of Fatigue 7 Management 8 The Role of Supportive Care 9 Conclusion 10 Corner, J., & Bailey, C. D., (2009), Cancer Nursing: Care in Context, John Wiley & Sons: New Jersey 11 RADIOTHERAPY IN CANCER CARE Background Cancer is the second cause of fatality, following the heart disease (American Cancer Society, 2008). It is then vital to comprehend the basics of radiation and treatment goals so as to deliver the best possible results in cancer patient care. Unfortunately, the widespread aspect of cancer, which by definition, affects the entire bone marrow and hence, every tissue supplied by the peripheral blood flow, made it difficult till recently to give curative radiotherapy without fatal over-irradiation. Radiotherapy is considered to be quite effectual for curative cancer, restricted control, and also reduction of pain and symptoms. Nevertheless, besides radiotherapy destroying the cancers cells, it also affects the normal tissues of the person receiving the treatment. This unintentional damage of normal tissues is often termed as toxicity. This toxicity often comes in hand with many sides effects. These include fatigue, radiation enteritis, nausea and vomiting, loss of appetite, hair loss, sore skin and joint or muscle stiffness. In this essay, the author brings out fatigue as the one of the symptoms of Radiotherapy. Rationale of choice In cancer treatment, fatigue is a common side effect of radiation treatment. Fatigue is the most distressing symptom. It is much beyond the burden caused by nausea and pain. Research has proved that more than 75% of the patients who undergo radiotherapy in their cancer treatment complain of fatigue during and after the process (Cancer Net, n.d). This has induced a negative effect on the management of cancer. This is because it sometimes becomes severe affecting the life of the patients (Barsevick, Dudley & Beck, 2006). According to Dr, Vogelzang report, about a third of the patients considered fatigue as the most significant symptom of radiotherapy while almost 70% described it as the worst side effect. Studies have found that fatigue and skin problems were the most frequently reported side effects of patients undergoing radiation for lung cancer, although levels of fatigue were higher at the start of treatment compared to women treated with radiotherapy for breast cancer (Corner, & Bailey, 2009). Literature review Introduction Fatigue is recognized as a common symptom of radiotherapy, which not only occurs during treatment but also continues after the Radiotherapy has ended. The incidence of moderate to severe fatigue following radiotherapy has been reported as between 32% and 59% of those undergoing treatment trajectories (Dauz, Duccy, Scars, et al, 2001). Research has shown that management of fatigue is often limited during radiotherapy, with an undue focus on anaemia-related problems rather than providing wider support (Wells, 2003). Action of Radiotherapy The action of radiotherapy can best be described as ionization radiation. In this process, the cancer cells are exposed to X-rays or gamma rays making them to loss proliferate capacity. This result to the death of these cells since the intracellular constituents’ structure is altered. This alteration is evident in cell division. Cancerous cells have a high rate of division that makes the vulnerable to attacks by these rays. These beams do not widen much as they penetrate in the tissues as they have little lateral scatter. It is well known that the application of radiotherapy results to the interaction of radiation rays with the cancerous cells and the radiosensitive normal tissue and organs. Interfering with organs and tissues like kidney, nervous tissues and the skin may affect the blood circulation in the human body. This results to the sides effects like lack of appetite and fatigue. Occurrence of Fatigue The etiology of fatigue may be linked to certain sites of treatment. For instance, in radiotherapy to the chest, such as the treatment of breast cancer, the inclusion of sensitive lung tissues within the radiotherapy field may be linked to the fatigue. Fatigue can also be exacerbating by the occurrence of radiation-induced pneumonitis (Wells, 2003). The pattern of the fatigue following radiotherapy varies depending on the site and stage of therapy. Fatigue is seen to increase over the course of radiotherapy treatment but has different incidence depending on the site and disease. Studies have shown that fatigue continue even after completion of therapy. In a research done, 39% of the patients were still experiencing fatigue at three months following radiotherapy treatment. Moreover, the severity of fatigue for patients undergoing radiotherapy has been defined by patient self-report (Dauz, Duccy, Scars, et al, 2001). The effect of fatigue after radiotherapy is also dependent on gender. Studies have shown that men and women experienced different patterns of symptoms following radiotherapy to the pelvic area, men experiencing a lower incidence of fatigue. Women experienced increasing levels of fatigue over the course of the treatment, and it was worse in the afternoon. Intracavitary treatment for gynecological disease has been found to add to the extent of fatigue symptoms (Nail, L., 1993). Fatigue is also a debilitating symptom of cranial irradiation for brain tumors. Studies that had been done showed that patients complained of feeling fatigued, drowsy and lethargic after radiotherapy treatment (Faithful 1991). Factors That Influence the occurrence of Fatigue It may be difficult to determine who may be badly affected by the radiotherapy treatment. In mediating cancer-related fatigue, functional status is taken as the most vital factor put into consideration (Goldstein, Bennett, Friedlander, et al, 2006). The physical complications of radiotherapy are linked not only to the cell types within the treatment field, but also to the volume and dose. The site of the treatment is also predictive. Another factor that influences the occurrence of fatigue, is adjuvant therapy or surgery at the time of, or before, radiotherapy treatment. In a survey of 403 patients who were receiving the various adjuvant treatments, 90% reported that treatment had an effect on their energy levels (Ayers, S., Baum, A., McManus, C, et al, 2007). Factors such as advanced disease, combined treatment modalities, and increased age are also significant, although other studies have not shown fatigue and age to be related. Fatigue may be more closely linked to frailty rather than chronological age. Differing in the fractionation regimens may be a factor in the severity of fatigue experienced. In the study of somnolence syndrome, those patients having accelerated fractionation with twice-daily cranial radiotherapy had more fatigue than those patients having once-daily treatments (Faithful and Brada, 1998). There are some patients who are more vulnerable to effects of radiotherapy than others, although it is not as yet, possible to identify those most at risk. Depression may make fatigue symptoms worse. Research examining symptom clusters in cancer patients demonstrates that these symptoms influence severity (Miaskowski, Dodd & Lee, 2004). Critical Analysis on Management of Fatigue The experience of fatigue can cause grand distress. Munro, et al, (1994) explored the distress associated with radiotherapy treatment by interviewing 72 patients to prioritize which symptoms or feelings were most distressing to them. Fatigue was ranked second to worries about the success of the therapy, but above other physical symptoms such as pain. The high levels of distress caused by fatigue could be a somatic expression of anxiety, and not simply a physical effect of radiotherapy. It is clear that psychological distress is an imperative variable in fatigue, being linked to physical symptoms such as pain (Richardson, 1995). Following radiotherapy, the experience of fatigue is so frequent that it is doubtful to be wholly a psychological manifestation. The distress of fatigue may be experienced in several ways, including the physical limitations of feeling exhausted and the social isolation that may result. Patients’ account on what the fatigue is like give a clear picture of lack of concentration, mental fogginess, and physical effects of experiencing fatigue as a result of radiotherapy treatment. Feelings of fatigue during radiotherapy for many are an expected result of having cancer therapy, but not following treatment, where the expectation is to recover quickly. The long duration and severity of fatigue symptoms experienced after radiotherapy has been completed can be frightening, and may not be understood to be a side-effect of radiotherapy treatment. It may be interpreted as a sign of the cancer progressing. Management By warning patients of the likelihood of fatigue occurring, and by providing information on strategies that may be helpful, the anxiety of unexpected symptoms can be prevented. However, there is little research evidence because at present fatigue interventions have not been adequately tested in cancer (Richardson, 1995). Exercise, stress management techniques and interventions aimed at reducing emotional distress may be effective ways to decrease feelings of fatigue (Winningham, 1991). When experiencing fatigue, most people tend to rest, nap or sleep; however, this may not be the most effective way to reduce fatigue (Pearce & Richardson 1994). In a study to examine which strategies were the most efficient in relieving fatigue associated with cancer treatment, sleep and exercise were found top be the most effective strategies (Graydon, Bubela, Irvine, et al, 1995). Most people suggest that fatigue management need to be tailored to what works for individual. A moderate walking exercise program has been found to manage fatigue, but prevention through exercising during treatment may be more effective than managing fatigue once it has developed (Mock, 2003). Appropriate assessment is vital in managing fatigue. It should be noted that anemia may also cause fatigue symptoms thus, should be excluded from someone complaining of fatigue. Assessment of fatigue symptoms should be subjective, for instance, asking someone to rate their fatigue on a scale of 0 to 10 may be useful (Winningham, Nail, Barton, et al, 1994). Also, it may be valuable if patients can be allowed to express in their own words how they would describe their fatigue. Quality of life issues in radiotherapy practice are only now begging to be addressed with tools that reflect the extent of fatigue symptoms. Interventions for fatigue are now being tested in a wider population. What is clear is that by taking the symptom seriously and offering support, information and advice, the distressing nature of this should be reduced. The Role of Supportive Care Supportive care has been a key element in the discussion of the management of the radiotherapy side effects in cancer care. Supportive care is defined as the provision of information, counseling, social support, and side effect management, with the aim of reducing radiotherapy morbidity. It is clear from the literature review that a few studies have been conducted to contribute to the knowledge that is required to provide evidence-based radiotherapy practice, and reflect the value or benefits of different approaches. The lack of consistency across the country and internationally in radiotherapy treatment strategies is also reflected in how adverse effects of therapy are managed (Burnet, Benson & Williams, 2000). Supportive care is a Cinderella area in radiotherapy and studies attests to this, with 1% reflecting quality of life assessments or the level of impact treatment can put on the individual, but it is clear that radiotherapy treatment can have a substantial impact on the person with cancer. The evidence about whether supportive and nursing care can make a difference to the individual, not only in terms of physical symptoms but also in terms of psychological distress, is not yet obvious, but it is probably to be of considerable benefit to well-being, recovery, and the experience of symptoms associated with radiotherapy treatment. Conclusion Fatigue intervention is an area where much nursing research has developed. There are no clear ideas as to the etiology and mechanism of radiotherapy-induced fatigue, and consequently interventions are mainly based on behavioral or psychological strategies. Fatigue is often an unexpected side-effect of treatment, and severity and effects of fatigue symptoms can be a surprise. Questions as to the best and most appropriate symptom management, follow-up services and surveillance during radiotherapy treatment are not adequately studied. The interface between follow-up cares, physical and psychological needs, and community services has been a neglected area. As cancer treatments become more complex, and chemotherapy regimes are increasingly combined with radiotherapy, nurses need to have the knowledge and skills to perfectly assess and intervene. REFERENCES American Cancer Society, (2008), cancer facts and figures 2008, Atlanta; GA Ayers, S., Baum, A., McManus, C, et al, (2007), Cambridge Handbook of Psychology, Health and Medicine, Cambridge University Press: Cambridge City Barsevick, A., Dudley, W., & Beck, S., (2006), Cancer-related Fatigue, depressive Symptoms, and Functional Status, Nursing Research; 55 Burnet, N., Benson, R., & Williams, M., (2000), Improving Cancer Outcomes through Radiotherapy, British Medical Journal; 320 Cancer Net, (n.d), Fatigue and Cancer, retrieved from, http://www.cancernet.co.uk/fatigue.htm Viewed on 6 October, 2012 Corner, J., & Bailey, C. 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