LUNG CANCER : NURSING

CONSIDERATION

Ns. AMELIA GANEFIANTY., M.Kep., Sp.Kep.M.B

Di sampaikan pada Zoominar “Orientasi Tata Laksana Kanker Paru”

Dinas Kesehatan Kota Bandung
Kamis, 9 September 2021
 LINGKUP BAHASAN

Latar Belakang 01

Konsep lung
02 cancer

Nursing Care 03
 Age-standardized rates (ASR) for lung cancer incidence worldwide.

2.1 million new lung cancer

diagnoses accounting for 12%
of the global cancer burden

Total Populations (2019)

270,625,567

Total # cancer cases (2018)

348,809
Total # cancer deaths (2018)
207,210

mordibity mortality
Matthew B. Schabath, and Michele L. Cote Cancer
12,6% 8,6%
Epidemiol Biomarkers Prev 2019;28:1563-1579

©2019 by American Association for Cancer Research

 Risk factor lung cancer worldwide Trends in cigarette and lung cancer–related death rates

Mazières J, Pujol JL, Kalampalikis N, Bouvry D, Quoix E, Filleron T, Targowla N, Jodelet D, Milia J, Matthew B. Schabath, and Michele L. Cote Cancer
Milleron B. Perception of lung cancer among the general population and comparison with other
Epidemiol Biomarkers Prev 2019;28:1563-1579
cancers. J Thorac Oncol. 2015 Mar;10(3):420-5. doi: 10.1097/JTO.0000000000000433. PMID:
25514806.
©2019 by American Association for Cancer Research
 Risk Lung Cancer Calculator

https://analysistools.cancer.gov/lungCancerScreening/#!/
 Histologic classification of lung cancer.

Matthew B. Schabath, and Michele L. Cote Cancer

Epidemiol Biomarkers Prev 2019;28:1563-1579

©2019 by American Association for Cancer Research

The role of advanced nursing in lung cancer
(Serena et al., 2015)

Serena, A., Castellani, P., Fucina, N., Griesser, A. C.,

Jeanmonod, J., Peters, S., & Eicher, M. (2015). The
role of advanced nursing in lung cancer: A framework
based development. European journal of oncology
nursing, 19(6), 740-746.
 Independent and interdependent role of
Advanced Practice Lung Cancer Nurse
(Serena et al., 2015)

Monitoring and
managing physical Providing patient/family
Psychosocial support symptoms and information regarding
providing symptom- disease and symptoms
management education

Coordination and Supporting the nursing

Continuity of care staff

Serena, A., Castellani, P., Fucina, N., Griesser, A. C., Jeanmonod, J., Peters, S., & Eicher, M. (2015). The role of advanced nursing in lung cancer: A framework based
development. European journal of oncology nursing, 19(6), 740-746.
 Psychosocial support
❖ Assess patient's psychological distress
❖ Provide emotional support to patients and family (i.e
reduce stress, anxiety, adjustment to illness, change
inbody image)
❖ Provide support concerning practical problems (i.e.
transportation, financial problems)

Monitoring and managing physical symptoms and providing

symptom-management education

❖ Assess patient's physical symptoms using the Lung Cancer Symptom Scale (Hollen et al.,
1999).
❖ Work with patient to identify uncomfortable disease related symptoms applying a
therapeutic education approach for self-monitoring and self-management at home.
❖ Discuss potential treatment side-effects and provide instruction for self-management (i.e.
breathlessness; fatigue; anorexia, sleep disturbances).
 Providing patient/family information regarding disease and symptoms
❖ Adjusting language to meet the patient's emotional state and
using lay language to explain the disease, procedures and
treatments.
❖ Provide information and written reference materials regarding
the disease, treatments, symptoms self-management and
external support possibilities (i.e. patient association).

Supporting the nursing staff

❖ Support the staff working with lung cancer patients (particularly other nurses), providing
expert information, advice and organizing time for dissemination about nursing or
supportive cares research results.
❖ Collaborate in research projects and in developing evidence-based nursing guidelines
(primarily in the field of nursing and secondarily in medical or other health sciences).
 Coordination and Continuity of care

❖ Refer patient and families to specialist

professionals (i.e. social worker, nutritionist, and
psycho-oncology) according to the severity of the
assessed psychological or physical problem.
❖ Attend weekly multidisciplinary tumor-board
meetings to provide ongoing clinical overview on
patients’ therapy and disease evolution.
❖ Organize multidisciplinary meetings with
patients/family to share viewpoints, develop
coherent therapeutic and enable patients to take
an active role in therapeutic decision-making.
Serena, A., Castellani, P., Fucina, N., Griesser, A. C., Jeanmonod, J., Peters, S., & Eicher, M. (2015). The role of advanced nursing in lung cancer: A framework based
development. European journal of oncology nursing, 19(6), 740-746.
Nursing Care
 Nursing Assesment Explore the patient's
(Toney-Butler TJ, Thayer JM, 2020 ) complaints or needs
Anamnesa before and during
illness

VALIDATION
1. Physical
Inspection
problems
Physical Auscultation
2. Psychological
Percussion
Assesment Palpation
problems

Compare interview
and physical
Diagnostic examination findings
with diagnostic tests
Toney-Butler, T. J., & Thayer, J. M. (2020). Nursing
process. StatPearls.
 KELUHAN UTAMA
1. Batuk lama
2. Batuk berdarah sesak nafas
3. Nyeri dada
4. Suara serak
5. Sulit/nyeri menelan yang tidak merespon dengan pengobatan atau penurunan
berat badan dalam waktu singkat
6. Nafsu makan menurun,
7. Demam hilang timbul
8. Sakit kepala
9. Nyeri di tulang atau parese
Anamnesa 10. Pembengkakan atau ditemukannya benjolan di leher, aksila atau dinding dada.
• Riwayat pengobatan
• Riwayat medis dan perawatan kanker saat ini
• Riwayat merokok dan riwayat sosial, termasuk paparan bahan kimia
• Riwayat psikososial (yaitu, adanya kelelahan, kecemasan, dan depresi)
• Riwayat gejala yang muncul dan data subjektif
• Tinjauan sistem dengan fokus pada sistem pernapasan dan gejala dispnea

Pedoman Nasional Pelayanan Kanker Paru Kemenkes RI, 2017.

 BILA PASIEN MERASAKAN
DYSPNEA
Tanyakan kepada pasien :
1. Apakah anda merasakan
cukup mendapatkan
udara?
2. Kapan anda merasakan
paling sesak nafas ? Saat
keadaan apa?
Anamnesa 3. Sesak saat ini bila
dibandingkan dengan
sebelumnya seperti apa?
4. Berapa lama waktu yang
Athey VL, Walters SJ, Rogers TK
Symptoms at lung cancer diagnosis are associated with major differences in anda butuhkan untuk
prognosis
Thorax 2018;73:1177-1181. bisa menarik nafas
panjang setelah aktivitas?
Dana Inzeo and Leslie Tyson, 2013
 Lung Cancer Symptom Scale (LCSS): patient scale

Hollen, P. J., Gralla, R. J., Kris, M. G., Cox, C., Belani, C. P., Grunberg, S. M., ... & Neidhart, J. A. (1994). Measurement of quality of life in patients with lung
cancer in multicenter trials of new therapies. Psychometric assessment of the Lung Cancer Symptom Scale. Cancer, 73(8), 2087-2098.
Lung Cancer Symptom Scale (LCSS): observer scale
 Inspeksi
Dinding dada, bentuk
dada, kesimetrisan

Palpasi
nyeri tekan dan abnormalitas
pada kulit yang berada di
atasnya, ekspansi dan taktil
fremitus

PEMERIKSAAN FISIK
Perkusi
Tentukan lokasi daerah
tersebut, dan tentukan
kualitas setiap bunyi perkusi
yang abnormal

KANKER PARU Auskultasi

Perhatikan bunyi
napas

Gleadle (2007) 20
 Darah rutin:
Hb, Leukosit,
Trombosit,
fungsi hati,
fungsi ginjal.

PEMERIKSAAN Analisa
LABORATORIUM Gas
Darah
KANKER PARU

Gleadle (2007)
21
 • Massa di paru-paru ditunjukkan pada foto
rontgen dada. Jika pada foto thoraks
ditemukan lesi yang dicurigai sebagai
keganasan
• CT scan menunjukkan massa, keterlibatan
kelenjar getah bening.
• Bronkoskopi dapat menunjukkan sel kanker;
dapat menampilkan lokasi tumor.
• Biopsi akan menunjukkan tipe sel: Biopsi jarum
PEMERIKSAAN melalui dinding dada untuk tumor perifer &
Biopsi jaringan dari paru untuk tumor yang
PENUNJANG lebih dalam.
• Pemindaian tulang atau CT scan menunjukkan
KANKER PARU metastasis penyakit.
(DiGiulio, Jackson, & Keogh, 2007)

22
Pengkajian
Psikologi
 Massa tumor/Sel Kanker ketidakseimbangan
nutrisi kurang dari
kebutuhan tubuh
penekanan pada
esofagus
disfagia

massa tumor
dalam bronkus nyeri menelan

hipersekresi bronkospasme gangguan aliran oksigen dalam penekanan massa

kelenjar mukus oksigen tubuh menurun pada vena cava
superior
peningkatan penurunan kolaps alveoli hipoksia jaringan
produksi sputum ekspansi paru batuk darah

obstruksi jalan hambatan metabolisme

nafas WOB meningkat anaerob ketidakefektifan
pertukaran gas
bersihan jalan
ketidakefektifan penumpukan nafas
bersihan jalan nafas sesak nafas asam laktat
intoleransi
aktifitas
penumpukan cairan ketidakefektifan pola
di rongga pleura nafas
cemas nyeri kronis
peningkatan
permeabilitas kapiler
 The impact of psychosocial stress and stress management on
immune responses in patients with cancer

Masalah ansietas
ditemukan pada 25%
atau lebih pada
pasien lung cancer

Pasien menunjukan kelelahan,

insomnia, anoreksia, pesimis,
menarik diri, putus asa,

Brintzenhofe-Szoc KM, Levin TT, Li Y, et al. Mixed anxiety/depression symptoms in a large Cancer, Volume: 125, Issue: 9, Pages: 1417-1431, First published: 15 February 2019, DOI: (10.1002/cncr.31943)
cancer cohort: prevalence by cancer type. Psychosomatics. 2009;50:383-91.
Manajemen
Dyspnea
pada pasien
Lung cancer
Tiep, Brian & Carter, Rick & Zachariah,
Finly & Williams, Anna & Horak, David
& Barnett, Mary & Dunham, Rachel.
(2013). Oxygen for end-of-life lung
cancer care: Managing dyspnea and
hypoxemia. Expert review of
respiratory medicine. 7. 479-90.
10.1586/17476348.2013.816565.
 Coun’t

Tiep, Brian & Carter, Rick & Zachariah,

Finly & Williams, Anna & Horak, David
& Barnett, Mary & Dunham, Rachel.
(2013). Oxygen for end-of-life lung
cancer care: Managing dyspnea and
hypoxemia. Expert review of
respiratory medicine. 7. 479-90.
10.1586/17476348.2013.816565.
Manajemen
Fatigue
pada pasien
Lung cancer
Mohandas H, Jaganathan SK,
Mani MP, Ayyar M, Rohini
Thevi G V. Cancer-related
fatigue treatment: An
overview. J Can Res Ther [serial
online] 2017 [cited 2021 Sep
7];13:916-29.
 FACIT-FATIGUE SCALE
Tidak sama Sedikit Sedang Cukup Sangat
No. Pertanyaan sekali banyak banyak
(0) (1) (2) (3) (4)

1 Saya merasa letih

2 Seluruh tubuh saya terasa lemah
3 Saya merasa lesu
4 Saya merasa lelah
5 Saya sulit memulai apa pun karena saya merasa lelah

6 Saya sulit menyelesaikan apa pun karena saya lelah

7 Saya mempunyai tenaga

8 Saya mampu melakukan kegiatan rutin saya

9 Saya perlu tidur pada siang hari

10 Saya tidak sanggup makan karena terlalu lelah

11 Saya memerlukan bantuan untuk melakukan kegiatan

rutin saya
12 Saya kecewa dan kesal karena terlalu lelah untuk
melakukan apa pun yang ingin saya lakukan
13 Saya harus membatasi kegiatan sosial saya karena saya
lelah
Fatigue dan
Aktivitas fisik
pada pasien
Lung cancer
Avancini, Alice & Sartori, Giulia &
Gkountakos, Anastasios & Casali,
Miriam & Trestini, Ilaria &
Tregnago, Daniela & Bria, Emilio &
Jones, Lee & Milella, Michele &
Lanza, Massimo & Pilotto, Sara.
(2019). Physical Activity and
Exercise in Lung Cancer Care: Will
Promises Be Fulfilled?. The
Oncologist. 25. 1-15.
10.1634/theoncologist.2019-0463.
Start Exercising Slowly, One Step at a Time
Start with light walking or stationary cycling for 10
minutes. Start at a level that feels easy—a 3 or 4 on a
scale of 10—and allows you to carry on a conversation
without effort.

Diaphragmatic Breathing
Sit, stand, or lie down. Place your hands on your
abdomen. Inhale through your nose, expanding your
abdomen into your hand as your lungs fill. Take a short
pause, then fully exhale through pursed lips, deflating
your abdomen and feeling your hand lower. Do two to
three sets of 10 to 15 reps.

Rows
Do two to three sets of 10 to 15 reps.
Step Ups
Stand tall in front of a low step with your feet hip-width apart. Hold
onto a railing or a sturdy chair for balance, and place your right foot
completely on the step. Drive up through your right thigh and place
your left foot onto the step. Pause, then step back down to the floor.
Do two to three sets of 10 to 15 reps on each foot.

Standing Hip Abductions

Shift your weight to your left foot. Keeping your right leg straight,
slowly lift it to the side. Pause, then slowly return your foot to the
floor. You can do this with or without a mini resistance band around
your thighs. Do two to three sets of 10 to 15 reps per leg.

Mini Squats
Place your hands on a kitchen counter or the back of a sturdy chair for
balance. Imagine you’re about to sit in a chair: Bend your knees and
send your hips back, sinking a few inches. Pause, then press through
your feet to stand. Do two to three sets of 10 to 15 reps.

Standing Heel Raises

Stand tall with your feet close together and place your hands on a
kitchen counter or on the back of a sturdy chair for balance. Keeping
your legs straight, raise up onto the balls of your feet, pause, then
lower your heels back to the floor. Do two to three sets of 10 to 15
reps.
 Kontrol nyeri
pada pasien
Lung cancer
Symptom Management in Patients
With Lung Cancer
1.Simoff, Michael J. et al.
2.CHEST, Volume 143, Issue 5,
e455S - e497S
 Palliative care (Ferrel et al., 2015)

Ferrell, B., Sun, V., Hurria, A., Cristea, M., Raz, D. J., Kim, J. Y., ... & Koczywas, M. (2015). Interdisciplinary palliative care for patients with
lung cancer. Journal of pain and symptom management, 50(6), 758-767.
 The ABCDE of interstitial lung disease care
(Kreuter et al., 2017)

Kreuter, M., Bendstrup, E., Russell, A. M., Bajwah, S., Lindell, K., Adir, Y., ... & Wijsenbeek, M. (2017). Palliative care in interstitial lung
disease: living well. The Lancet Respiratory Medicine, 5(12), 968-980.
 Save One Life, You’re a Hero
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