Faculty of Nursing

Alexandriauniversity.

Supervised by
Prof.Dr. Emad.

Prepared by/ Mahmoud Anwer Kamel El sakaan.

 Nursing care plan for patients with breast
cancer.

Outline.
*Modifiable risk Factors.
*BSE.
*Post mastectomy exercise.
*Diet.
*Body image.
*Role(chemathrapy,rediothrapy).
Modifiable risk factors

The potential for recurrence causes considerable distress for breast

cancer survivors. Major information sources for survivors and
providers offer few clear recommendations for postdiagnosis lifestyle
change related to recurrence. To design interventions to improve
long-term survivors′ care and quality of life, we must know what
survivors are doing to prevent recurrence in the absence of solid
evidence, whether survivors′ perceptions and behaviors correspond
to hypothesized modifiable risk factors for recurrence, and whether
survivors are adopting behaviors that could otherwise be harmful to
their health. Our review first addresses the general lack of
consensus on the impact of specific lifestyle factors on breast cancer
recurrence and the resulting equivocal lifestyle recommendations for
survivors. Second, we describe inadequacies of the studies of
survivors′ lifestyle changes related to recurrence. Because much of
the existing knowledge about modifiable risk factors for recurrence
comes from studies of survivors whose participation and behavior
change were potentially influenced by their concern about
recurrence, we need large, population-based observational studies
of randomly selected breast cancer survivors, adequately
representing the target population.
Critical are data on lifestyle change from prediagnosis to
postdiagnosis and changes over time after diagnosis, extensive data
on conventional and nonconventional treatments, and the temporal
relationship between behaviors and treatments, and inclusion of the
full complement of potential lifestyle risk factors for recurrence.
Understanding in detail the current status of survivors′ perceptions
and behaviors related to modifiable risk factors for recurrence can
provide considerable practical information to inform future
interventions and communication strategies for breast cancer
survivors
BSE

Breast self-examination (BSE) is widely recommended for brea st

cancer prevention. Following recent controversy over the efficacy of
mammography, it may be seen as an alternative. We present a
meta-analysis of the effect of regular BSE on breast cancer
mortality. From a search of the medical literature, 20 observati onal
studies and three clinical trials were identified that reported on
breast cancer death rates or rates of advanced breast cancer (a
marker of death) according to BSE practice. A lower risk of mortality
or advanced breast cancer was only found in studie s of women with
breast cancer who reported practising BSE before diagnosis
(mortality: pooled relative risk 0.64, 95% CI 0.56 –0.73; advanced
cancer, pooled relative risk 0.60, 95% CI 0.46 –0.80). The results are
probably due to bias and confounding. There was no difference in
death rate in studies on women who detected their cancer during an
examination (pooled relative risk 0.90, 95% CI 0.72 –1.12). None of
the trials of BSE training (in which most women reported practising it
regularly) showed lower mortality in the BSE group (pooled relative
risk 1.01, 95% CI 0.92–1.12). They did show that BSE is associated
with considerably more women seeking medical advice and having
biopsies. Regular BSE is not an effective method of reducing breast
cancer mortality.

Post mastectomy exercise

Lymphedema is a debilitating complication following mastectomy,
affecting the arm functions and quality of life (QOL) effects of upper-
limb exercises on lymphedema in clinical settings. However, there is
a dearth of evidence regarding the effect of home-based exercises
on lymphedema; therefore, we examined the effect of a home-based
exercise program on lymphedema and QOL in postmastectomy
patients. Thirty-two female postmastectomy lymphedema patients
participated in an individualized home-based exercise program for 8
weeks. Arm circumference, arm volume, and QOL (36-Item Short
Form Health Survey) were measured before and after the program.
Data were analyzed with the use of paired t-tests for circumferential
and volumetric measures and Wilcoxon signed ranks tests for QOL.
with Bonferroni correction 0.01 <Significance level was set at p
(alpha/n= 0.05/5= 0.01). Analysis showed a statistically significant
improvement in the affected upper-limb circumference and volume
at )0.001 <and in the QOL scores (p )0.001 <(~ 122 mL reduction, p
the end of the home-based exercise program. The individualized
home-based exercise program led to improvement in affected upper-
limb volume and circumference and QOL of postmastectomy
lymphedema patients.
Diet
What to eat during breast cancer treatment
If you don’t have nutrition-related side effects from your cancer
treatment that limit your ability to eat and/or digest food, Taylor says
you can follow a generally healthy diet that includes:

Fruits and vegetables: 5+ servings a day. Fruits and vegetables

contain antioxidant and anti-estrogen properties. Cruciferous
vegetables such as broccoli, cauliflower, kale, cabbage and Brussels
sprouts are especially good to include and are rich in
phytochemicals.

Whole grains: 25-30 grams of fiber daily. Whole grains are

unprocessed foods that are high in complex carbohydrates, fiber,
phytochemicals as well as vitamins and minerals. A study by
researchers at Soochow University in Suzhou, China, found that high
fiber intakes may have a positive effect by altering hormonal actions
of breast cancer and other hormone-dependent cancers.

Lean protein — and soy, too. For good protein sources, increase your
intake of poultry, fish and legumes like beans and lentils. Minimize
your intake of cured, pickled and smoked foods. Soy in moderate
amounts, which means one to two servings/day of whole soy foods
(like tofu, edamame and soy milk) also can be included. Studies,
including research reported in the American Institute for Cancer
Research, show that animals metabolize soy differently than
humans. Not only is soy safe in moderate amounts, but research
shows that soy contains isoflavones, a phytonutrient wi
th anti-cancer properties. Up to three servings of whole soy foods
per day doesn’t increase a breast cancer survivor’s risk of recurrence
or death.

Alcohol in moderation, if at all. Drinking

alcohol is a known risk factor for breast cancer. A large,

observational study of 105,986 women suggested that drinking
three glasses of wine or more per week throughout life increases
a woman’s risk of breast cancer by a small but significant
percentage. The study saw a 15% increased risk of breast cancer
when women drank an average of three to six drinks per week,
compared to women who did not drink. Try to avoid intake of
alcoholic beverages when possible.

Body image
Body image is an important endpoint in quality of life evaluation
since cancer treatment may result in major changes to patients'
appearance from disfiguring surgery, late effects of radiotherapy or
adverse effects of systemic treatment. A need was identified to
develop a short body image scale (BIS) for use in clinical trials. A
10-item scale was constructed in collaboration with the European
Organization for Research and Treatment of Cancer (EORTC)
Quality of Life Study Group and tested in a heterogeneous sample of
276 British cancer patients. Following revisions, the scale underwent
psychometric testing in 682 patients with breast cancer, using
datasets from seven UK treatment trials/clinical studies . The scale
showed high reliability (Cronbach's alpha 0.93) and good clinical
validity based on response prevalence, discriminant validity
(P<0.0001, Mann–Whitney test), sensitivity to change (P<0.001,
Wilcoxon signed ranks test) and consistency of scores from different
breast cancer treatment centres. Factor analysis resulted in a single
factor solution in three out of four analyses, accounting for >50%
variance. These results support the clinical validity of the BIS as a
brief questionnaire for assessing body image changes in patients
with cancer, suitable for use in clinical trials.

Role (chemathrapy,rediothrapy).
PURPOSE:Because toxicities associated with chemotherapy and
radiotherapy canadversely affect short- and long-term patient quality
of life, can limitthe dose and duration of treatment, and may be life -
threatening, specificagents designed to ameliorate or eliminate
certain chemotherapy andradiotherapy toxicities have been
developed. Variability in interpretationof the available data pertaining
to the efficacy of the three United StatesFood and Drug
Administration–approved agents that have potentialchemotherapy-
and radiotherapy-protectant activity—dexrazoxane,mesna, and
amifostine—and questions about the role of theseprotectant agents
in cancer care led to concern about the appropriate useof these
agents. The American Society of Clinical Oncology sought
toestablish evidence-based, clinical practice guidelines for the use
ofdexrazoxane, mesna, and amifostine in patients who are no t
enrolled onclinical treatment trials