• Chapter 31

Cancer

• Introduction

• Cancer as the second leading cause of death in persons age 65 and older

• Probability of developing cancer increases with age

• Role of the gerontological nurse:

– Prevention

– Diagnosis

– Treatment

Aging and Cancer

• Unique challenges for older persons with cancer:

– Advanced stage when initially diagnosed

– Multiple health conditions

– Increased risk of complications, disability, and death

– Treatment challenges

Despite having the highest rate of most cancers, older adults have the lowest rate of receiving
early detection tests for cancer; thus, their disease may be in an advanced stage when diagnosed.

• Explanations for increased incidence of cancer in older adults:

– Two major theories:

o Biological age-related changes

o Prolonged exposure to carcinogens

• Cancer Risk Factors

• Heredity

– Certain types of cancers: breast cancer

• Diet

– High fat, chemicals in meat, fried or barbecued meat

 – Inconclusive research related to food additives, aspartame, and coffee

• Drinking water

– Contamination

• Tobacco

– Smoking as a significant cause of many types of cancer

• Alcohol

– Increased risk of certain types of cancer

• Radiation

– Cellular phones and X-rays

• Ultraviolet radiation

– Risk of skin cancer

• Occupational exposure to carcinogens

• Radon

• Special Risks for Women

• Increased risk for ovarian and breast cancer

– Genetic factors

– Other risk factors

• Increased risk for vaginal cancer

• Increased risk of ovarian cancer in those who have had colon cancer

Other Contributing Factors

• Stress and immune function

• Dental conditions

• Theories continue to grow

• Nurses need to carefully evaluate the research

 Prevention and Screening

• Review of risk factors leads to identification of preventive measures

• Healthy lifestyle factors to minimize risks

• Health education and counseling

• Screening measures will improve outcomes

• Need for early detection

• Treatment

• Conventional treatment:

– Type of treatment depends on the specific cancer

– Surgery, radiation, chemotherapy, and biologic therapy

– Unique risks for older adults

• Complementary and alternative medicine:

– Special diets, psychotherapy, spiritual practices, vitamin supplements, and herbal

remedies

– Holistic orientation

– Treatment of the entire person, not just the disease

– Need to weigh risks and benefits

• Advantages of Care Provided by Complementary Practitioners

• Relationship-centered care

• Support

• Healing partnerships

• Comfort

Healing partnerships allow complementary and alternative practitioners to honor patients’

rights to control their care and their lives, seeing their role as empowering, facilitating, and supporting
patients in the healing process.

• Nursing Considerations for Older Adults With Cancer

• Patient education
• Increase awareness of measures to prevent cancer

• Understanding of warning signs of cancer

• Self-examination

• Cancer screening tests

C – Change in bowel or bladder habits

A – A sore that does not heal

U – Unusual bleeding or drainage

T – Thickening or lump in the breast or elsewhere

I – Indigestion or swallowing difficulty

O – Obvious change in a wart or mole

N – Nagging persistent cough or hoarseness

• Promoting optimum care

• Choice of a treatment facility

• Clinical trials

• Care after radiation and chemotherapy with knowledge of the increased risks related to age-
related changes

• Prevention of complications

• Knowledge of certain types of cancer

• Providing support to patients and families

• Diagnosis may be overwhelming and stressful

• Fear

• Cost of treatment

• Consult with the physician

• Assess patient and family understanding and allow expression of feelings