The nursing of skin metastasis on the puncture site of peripherally inserted central catheter in a patient with lung cancer.

OBJECTIVE: To report a case of lung cancer metastasizing to skin from peripherally inserted central catheter puncture and to analyze the causes and treatment of this event. METHODS: In August 2016, one patient with lung cancer developed a nodule on the puncture site of peripherally inserted central catheter. The nodule was 1 cm × 1 cm in size and soft in texture, whose color was similar to that of the skin; the surface was smooth and integral without tenderness, bleeding, or exudates. After removing the catheter, the nodule ruptured and was liable to bleeding on touching and grew up gradually ever since. Cytological examination of the nodule revealed tumor cells infiltration, after which nodule resection was performed. RESULT: The patient's wound healed up well, and no other masses were found on the skin surface around the whole body. The pathological examination of the surgical specimen suggested metastatic pulmonary adenocarcinoma. CONCLUSION: The case of lung cancer metastasizing to skin from peripherally inserted central catheter puncture is rare and may be attributed to the aggressiveness of tumor, the age of the patient, and the duration and location of peripherally inserted central catheter. Active treatment of distant metastasis could improve the life quality and prolong the survival of the patients.

Understanding immunotherapy for the treatment of non-small cell lung cancer.

Patients diagnosed with advanced non-small-cell lung cancer (NSCLC) (either squamous or non-squamous) have previously had limited treatment options after progression on chemotherapy. With the emergence of new drugs, particularly in the immuno-oncology setting, this is now changing. Recent clinical trial evidence demonstrates that compared with docetaxel, patients who received nivolumab had better overall survival and also significantly fewer grade 3-4 adverse events. This article reviews the clinical trial data for nivolumab and provides an overview of how this drug works. The adverse event profile of nivolumab is assessed and compared to that of docetaxel. The important role that nurses can play in supporting patients on nivolumab is also discussed.

CE: Human Papillomavirus-Related Oropharyngeal Cancer: A Review of Nursing Considerations.

: The overall incidence of head and neck cancer-which includes laryngeal, hypopharyngeal, nasal cavity, paranasal sinus, nasopharyngeal, oral, oropharyngeal, and salivary gland cancers-has declined in the United States over the past 30 years with the concomitant reduction in tobacco use. Over that same period, however, the worldwide incidence of oropharyngeal cancer has escalated significantly, most notably among men and women under age 60 who live in developed countries. This epidemic rise in oropharyngeal cancer is largely attributed to certain genotypes of the human papillomavirus (HPV). In the United States, HPV prevalence in oropharyngeal tumors increased dramatically, from roughly 16% between 1984 and 1989 to nearly 73% between 2000 and 2004, and the annual incidence of HPV-positive oropharyngeal cancer is expected to surpass that of HPV-related cervical cancer by 2020.This article provides an overview of head and neck cancer-its incidence, risk factors, treatment, and posttreatment sequelae-with a focus on HPV-related oropharyngeal cancer. Unlike other forms of head and neck cancer, HPV-related oropharyngeal cancer tends to affect younger patients with few or none of the traditional risk factors and has a distinctive presentation, histology, and natural course. In order to provide appropriate patient education and to help these patients monitor and manage late and long-term treatment effects, it is important for nurses to be aware of this disease and its treatment, and of the unique survivorship issues that arise for affected patients.

Diagnosis, treatment and management of epidermolysis bullosa.

Epidermis bullosa is a genetically inherited disease in which painful blistering of the skin or mucous membranes occurs after minor trauma. It is a lifelong problem. The diagnosis should be confirmed by a specialist, preferably at a specialist unit where a treatment plan and follow-up arrangements for professionals and families can be put in place. Nurses will be involved in frequent dressings of wounds, after extra analgesia, and may need to be alert to any need for further specialist referral, especially in the case of complications such as infection, deformities, gastrointestinal strictures and possible skin cancers. Genetic counselling should also be offered to families, especially when considering the possible risks to future pregnancies.

Nonmelanoma skin cancer: disease-specific quality-of-life concerns and distress.

PURPOSE/OBJECTIVES: To provide a better understanding of the disease-specific quality-of-life (QOL) concerns of patients with nonmelanoma skin cancer (NMSC). DESIGN: Cross-sectional. SETTING: Skin cancer clinic of Jewish General Hospital in Montreal, Quebec, Canada. SAMPLE: 56 patients with basal cell carcinoma and/or squamous cell carcinoma. METHODS: Descriptive and inferential statistics applied to quantitative self-report data. MAIN RESEARCH VARIABLES: Importance of appearance, psychological distress, and QOL. FINDINGS: The most prevalent concerns included worries about tumor recurrence, as well as the potential size and conspicuousness of the scar. Skin cancer-specific QOL concerns significantly predicted distress manifested through anxious and depressive symptomology. In addition, the social concerns related to the disease were the most significant predictor of distress. CONCLUSIONS: The findings of this study provide healthcare professionals with a broad picture of the most prevalent NMSC-specific concerns, as well as the concerns that are of particular importance for different subgroups of patients. IMPLICATIONS FOR NURSING: Nurses are in a position to provide pivotal psychosocial and informational support to patients, so they need to be aware of the often-overlooked psychosocial effects of NMSC to address these issues and provide optimal care.

Factors relating to quality of life after esophagectomy for cancer patients in Taiwan.

BACKGROUND: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries. OBJECTIVE: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan. METHODS: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery. RESULTS: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL. CONCLUSIONS: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Psychological functioning of caregivers for head and neck cancer patients.

Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.

Food restrictions of patients who are undergoing treatment for oral and oropharyngeal cancer.

PURPOSE: Oral squamous cell carcinoma and its treatment are associated with facial disfigurement and functional inabilities that may lead to malnutrition or under nourishment. This study assessed the incidence of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. METHOD: We interviewed 120 patients in two hospitals in São Paulo, Brazil, using a structured food frequency questionnaire comprising the most commonly consumed foods in Brazil. This questionnaire was applied twice; the first time to inform dietary patterns prior to the diagnosis of cancer and the second time to assess recent modifications of diet that were associated with the disease and its treatment. Hospital files provided information on clinical status. Multivariate Poisson regression models assessed covariates with prognostic value. RESULTS: One third of patients suffered major food restrictions (i.e., they reduced substantially the intake of more than 50% of the most commonly consumed food items before the diagnosis); 39% suffered a less severe condition (they could not eat less than 50% of the most commonly consumed food items before the diagnosis, and they needed changes in food preparation). Larger tumour size (adjusted incidence ratio IR = 1.45), posterior location (IR = 1.33), radiotherapy (IR = 1.84), loss of tongue mobility (IR = 1.36) and loss of teeth (IR = 1.25) in the surgery were associated significantly with the study outcome. CONCLUSION: This study identified clinical predictors of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. This knowledge may contribute to improve patient care and management, and to develop interventions aimed at preventing nutritional depletion of these patients.

When negative rights become positive entitlements: complicity, conscience, and caregiving.

Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals "against medical advice" are typically allowed to do so. But what happens when they require clinicians' assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients' requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical framework wherein clinicians can honor patients' wishes without necessarily sacrificing their own moral position.

Surgical management of head and neck carcinoma.

OBJECTIVES: To describe surgical approaches to the management of head and neck cancers and discuss postoperative management and challenges in rehabilitation of patients with head and neck cancer. DATA SOURCES: Peer reviewed journals, reference books, research studies. CONCLUSION: Surgical management of tumors in the head and neck is complex and challenging. It is influenced by tumor size, location, previous treatment, and histopathology. Technologic advances have led to better preoperative planning, improved intraoperative interventions, decreased postoperative functional defects, and extended survival in select cases. IMPLICATIONS FOR NURSING PRACTICE: A multidisciplinary oncology team approach to care is essential to successful outcomes. Basic survival skills such as breathing, eating, and communicating are all subject to compromise as a result of the disease process and treatment.

Systemic therapies for squamous cell carcinoma of the head and neck.

OBJECTIVES: To discuss current clinical recommendations for treatment of squamous cell carcinoma of the head and neck (SCCHN), to identify common toxicities associated with combined chemoradiotherapy or chemotherapy alone, and describe strategies for management of the most common treatment-related toxicities. DATA SOURCES: Current research, published literature, National Comprehensive Cancer Network Clinical Practice Guidelines, American Society of Clinical Oncology, and Oncology Nursing Society. CONCLUSION: Advances in options for systemic therapy for SCCHN have provided hope for patients with this disease. However, effective management of these patients requires a proactive and persistent multidisciplinary treatment approach, including toxicity management. IMPLICATIONS FOR NURSING PRACTICE: Careful evaluation of each patient before initiating treatment with the goals of therapy reviewed by the multidisciplinary team, the patient, and the caregivers, will allow selection of the most appropriate treatment plan. The goals of therapy should provide guidance in balancing tumor response, toxicity (both acute and late effects), survival, and quality of life.

A palliative approach to the management of malodour from malignant fungating tumours.

The aim of this case study is to explore the role of palliative care and the importance of a multidisciplinary team approach for the management of malodour from malignant fungating tumours. Nurses in my practice area in the UK rarely see them, find them particularly difficult to manage and the experience is often personally distressing. The disturbing nature of these tumours inflicts so much suffering on the patient and those around them that the concept of palliative care is often severely challenged and can prove to be difficult for nurses to achieve. Palliative care aims to provide a holistic team approach in addressing the complex individual needs of these patients and their families.

Topical photodynamic therapy: an introduction for nurses.

Non-melanoma skin cancers are the most common cancers in the UK. Although an estimated 50000 cases were registered in 1999 across England and Wales, there is likely to be significant under-reporting of cases. However, the cancer registries do not include pre-cancerous lesions of the skin and therefore the number treated will greatly outnumber the cancers (National Institute for Health and Clinical Excellence, 2006). Topical photodynamic therapy (PDT) is one of several effective treatments for pre-malignant and malignant non-pigmented skin cancers. The treatment is non-invasive and can be administered by nurses in a clinical setting. PDT is a two-step process involving the application of a light-activated substance followed by exposure to light to activate this substance. The treatment results in the elimination of tumour cells while leaving the healthy skin unharmed. This article provides an introduction to PDT for nurses who may in the future be involved in setting up a PDT service within their practice area.