Chapter 16: Cancer Nursing Care

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Imagine that moment, maybe you've seen it with a patient or even a loved one, when someone hears the word cancer, it's just a seismic shift, isn't it?

It absolutely is.

Instantly, there's this rush of fear, anxiety,

and just this overwhelming need to understand a whole new, complex world.

And that's exactly where you, as future nurses, come in.

Welcome to the Deep Dive.

Today we're diving into Chapter 16 of Lewis's Medical -Turgical Nursing.

We're focusing on cancer assessment and management.

Our goal here is to really break down this dense information into something clear, structured, and honestly useful for you.

We want to equip you with that core understanding of cancer.

Exactly.

It's not just about the textbook facts.

It's about what this disease means for the people you'll care for and how you can genuinely make a difference.

Because cancer isn't just one thing, right?

Not at all.

It's a whole group of diseases, really.

The common thread.

Uncontrolled, unregulated cell growth.

And the impact goes way beyond the physical.

It affects patients psychologically, socially.

It's immense.

And nurses are right there on the front lines.

Prevention, early detection,

compassionate care.

It's a huge role.

Absolutely pivotal.

So this Deep Dive, it's designed to translate that complex textbook knowledge into practical insights for your clinical work, and yes, for tackling those NCLEX -style questions.

Okay, let's get into it.

Starting right down at the cellular level.

What's actually going wrong when cancer starts?

Well,

fundamentally, you're looking at two big problems.

Defective cell proliferation, that's the growth part, and defective cell differentiation, how cells specialize.

Okay, proliferation.

Normal cells have limits.

They do.

Normally, cell growth is balanced.

Cells grow, they mature, they do their job.

Eventually, they die off and get replaced.

It's orderly.

And they have something called contact inhibition.

Meaning they stop growing when they touch each other, like respecting personal space.

Exactly like that.

Normal cells respect boundaries.

Cancer cells, they lose that.

They keep growing, even piling up on top of each other.

That's the pyramid effect you sometimes hear about.

So uncontrolled growth, and this connects to doubling time.

Yes.

Doubling time is simply how long it takes for a tumor mass to double its size.

A shorter doubling time usually means a more aggressive cancer.

Okay, that's proliferation.

What about the second problem, defective differentiation?

Right.

Normally, cells mature and get very specialized.

A liver cell becomes a liver cell.

A skin cell becomes a skin cell.

Cancer cells, though, can kind of de -differentiate.

They go backward, becoming more immature or less specialized.

So they lose their specific function.

Pretty much.

Sometimes they even start looking and acting like fetal cells again.

They forget their original purpose.

Wow.

And all of this ties back to our genes, doesn't it?

It absolutely does.

It's all about malfunctions in the genes that control this whole process of growth and specialization.

Talk about proto -cogens and on -cogens.

How does that work?

Okay, so we all have proto -hote genes.

These are normal genes, essential regulators of cell growth.

Think of them like a gas pedal in a car, necessary but needs control.

But if a mutation happens in a proto -cogagen, it can turn into an on -cogene.

That's like the gas pedal getting stuck down.

The GO signal for cell growth is permanently switched on.

And then there are the breaks,

the tumor suppressor genes.

Exactly.

Genes like BRCA1, BRCA2, you've probably heard of those, and P53, these are natural breaks.

They slow down cell division, repair DNA mistakes, or tell cells to die if they're damaged beyond repair.

So if those get inactivated?

Then the breaks fail.

Uncontrolled growth can happen, and the risk of certain cancers like breast, ovarian, colorectal goes way up.

It really sounds like a multi -step process, not something that happens instantly.

How does it typically unfold?

You're right.

It's usually an orderly kind of slow burn process, often involving multiple factors over time.

We generally talk about three stages.

Initiation, promotion, and progression.

Initiation is the first hit.

That's the one.

It involves a mutation, a change in the cell's DNA sequence.

Now, this mutation could be inherited that accounts for maybe 5 -10 % of cancers, but most are acquired during a person's lifetime due to damage.

Damage from what?

What causes these initial mutations?

Often, exposure to carcinogens, things that cause cancer.

These can be chemicals, you know, benzene or asbestos.

Radiation is another big one.

UV radiation from the sun is a major cause of skin cancer.

And viruses too, right?

I remember reading about that.

Yes, definitely.

Certain viruses are oncogenic.

Epstein -Barr virus is linked to Burkitt lymphoma, HIV to Kaposi -Sacoma, hepatitis B significantly increases liver cancer risk, and HPV.

Well, HPV is a major cause of cervical, anal, and some head and neck cancers.

Knowing these links is key for prevention and screening.

Okay, so a cell gets initiated.

What happens in the promotion stage?

Promotion is where these altered cells start to multiply.

But here's the really crucial part, especially for nursing and patient education.

The activity of promoters is often reversible.

Reversible?

How?

Well, promoting factors are things like obesity, heavy alcohol use, and definitely cigarette smoking.

Smoking is actually considered a complete carcinogen because it acts as both an initiator and a promoter.

So lifestyle changes can actually make a difference even after initiation.

A huge difference.

This is where prevention strategies really shine.

It's estimated something like 40 % of cancers could potentially be avoided through lifestyle changes.

This promotion phase combined with initiation makes up the latent period.

The time between the first change and actually finding the cancer.

Exactly.

This can be years, even decades.

A tumor usually has to grow to about a centimeter.

That's earlier, maybe a half a centimeter.

And then the final stage is progression.

What defines that?

Progression is characterized by increased growth rate,

increased invasiveness into surrounding tissues, and crucially, metastasis.

Metastasis is the spread to distant parts of the body.

How does that happen?

It's complex.

The tumor develops its own blood supply that's tumor angiogenesis.

Then cells can detach from the main tumor, invade nearby tissue, and get into the blood stream or the lymphatic system.

So they travel through the body's highways.

Essentially, yes.

If they travel via blood, it's called hematogenous metastasis.

They can then lodge in distant organs like the lungs, liver, bone, or brain.

Those are common sites.

If they use the lymphatic system, we often check the sentinel lymph node, the first node draining the tumor area to see if it's spread.

We have this amazing immune system.

Doesn't it fight back against cancer cells?

It absolutely tries.

Our immune system performs what we call immunologic surveillance.

It's constantly checking cells for non -self markers, including altered antigens on cancer cells called tumor -associated antigens, or TAAs.

And which immune cells are the main players?

Cytotoxic T cells are key fighters.

Natural killer, or NK cells, are also important because they can kill tumor cells without needing prior sensitization.

Macrophages and B cells play roles, too.

But clearly, the immune system doesn't always win.

How do cancer cells manage to escape?

They're quite crafty.

They can develop ways to suppress the T cells, or their surface antigens might be weak and hard for the immune system to recognize.

Sometimes they even shed antigens that act like decoys or trigger tolerance.

It's an ongoing battle.

You mentioned tumor markers earlier, like CEA and PSA.

Are those related to the immune response?

Not directly to the escape, but they are related to altered cell function.

Some cancer cells start producing oncofital antigens, again proteins normally made only during fetal development.

CCA and AFP are examples.

So how are they used clinically?

Primarily as tumor markers.

Things like CEA for colorectal cancer, CO125 for ovarian, PSA for prostate, HGR2 for breast cancer.

They can help monitor how well treatment is working, or detect if cancer has recurred.

But, and this is important, they aren't specific enough for initial diagnosis usually.

Many things can elevate them.

Okay, so once cancer is diagnosed,

classifying and staging it becomes critical.

Why is that system so important?

It's all about communication and planning.

Having a standardized system lets everyone, doctors, nurses, researchers speak the same language.

It helps determine the best treatment approach, predict the likely prognosis, and compare outcomes across different studies or centers.

The first big distinction is benign versus malignant, right?

Right.

Benign tumors don't invade surrounding tissues or spread.

Malignant tumors do, that's the defining feature.

They invade and metastasize.

And how else do we classify them?

We look at the anatomic site, the tissue where it originated.

So carcinomas arise from epithelial tissues like skin or glands.

Sarcomas come from connective tissues like bone or muscle.

Lymphomas and leukemias start in the hematopoietic system.

There's also grading.

How does that work?

Histologic grading looks at how abnormal the cancer cells appear under a microscope and how closely they resemble the normal tissue.

Grade I cells are well differentiated, look fairly normal, and tend to be less aggressive.

Grade IV cells are poorly differentiated, very immature looking, and usually indicate a more aggressive cancer with a poorer prognosis.

And then the staging TNM is the common one?

Yes.

The TNM system is widely used for solid tumors.

T stands for tumor size and invasiveness.

N stands for regional lymph node involvement, has it spread to nearby nodes.

And M stands for distant metastasis, has it spread to other parts of the body.

So combining T, N, and M gives you an overall stage.

Exactly.

It helps determine the clinical stage, ranging from stage zero, cancer in situ, meaning it hasn't invaded, up to stage four, metastatic cancer.

This staging is absolutely crucial for guiding treatment choices, though it's worth noting TNM isn't used for all cancers, like leukemias, which aren't solid tumors.

Okay, shifting gears slightly.

As nurses, prevention, and early detection, that's a huge part of our role.

What are the absolute key messages we need to get across?

It's massive.

We need to be constantly educating patients, limit alcohol intake, get regular physical activity, maintain a healthy weight, protect your skin from the sun, and crucially, avoid all tobacco products, smoking, chewing, vaping.

And screenings.

Absolutely vital.

Regular mammograms, Pap tests, colorectal cancer screenings.

These save lives by catching cancer early when it's often most treatable.

And those classic seven warning signs of cancer, which you all know these by heart, right?

Definitely.

Use the acronym CAUTION.

Change in bowel or bladder habits.

A sore that doesn't heal.

Unusual bleeding or discharge.

Thickening or lump in the breast or elsewhere.

Indigestion or difficulty swallowing.

Obvious change in a wart or mole.

Nagging cough or hoarseness.

Any of those warrant immediate medical attention.

Without a doubt, teach patients not to ignore these signs.

Hearing a cancer diagnosis is terrifying.

How can nurses best support patients and families during that diagnostic workup?

Empathy and presence are key.

You're often the main point of contact.

Your role is to help coordinate their care, explain the tests, and understand the language, and maybe most importantly, just listen.

Actively listen to their fears, their questions.

And avoid platitudes.

Please.

Avoid false reassurances like, everything will be okay.

Instead, offer realistic support.

Acknowledge their fear.

Help them navigate the system.

And remember, the definitive diagnosis usually requires a biopsy.

The tissue sample.

Yes.

That's the only way to be absolutely sure if it's cancer and, if so, what specific type and grade it is.

That information drives everything that follows.

So, once the diagnosis and staging are done, what are the main goals of treatment?

What are we trying to achieve?

Broadly, there are three main goals.

Cure, control, or palliation.

Cure is obviously the ideal outcome.

Of course.

That means completely eradicating the cancer.

Possible for some cancers, especially when caught early, like certain skin cancers or testicular cancer.

And control.

Control means managing the cancer when a cure isn't likely.

Treating it more like a chronic illness, like diabetes or heart disease.

The goal is to extend life and maintain quality of life with ongoing therapy.

Multiple myeloma is often managed this way.

And palliation focuses on comfort.

Exactly.

Palliation is all about relieving symptoms, managing pain, and improving quality of life, even if the cancer itself can't be stopped.

Think about radiation to shrink a tumor pressing on a nerve to relieve pain.

Importantly, palliative care can and often should happen alongside curative or control -focused treatments.

Let's dive into the major treatment types.

Chemotherapy is probably the one most people think of first.

It's a cornerstone, yes.

Chemotherapy uses drugs that travel throughout the body.

It's a systemic treatment to kill or slow the growth of cancer cells.

How does it actually work on the cells?

Chemo drugs typically target cells that are rapidly dividing.

That's why they're effective against cancer cells, which usually divide quickly.

That's also why they cause side effects, right?

Because other normal cells divide quickly too.

Precisely.

Think about the cells lining your mouth and gut.

Your hair follicles, your bone marrow cells, they divide rapidly too.

So they often get damaged by chemo, leading to those common side effects, like mouth sores, nausea, hair loss, and low blood counts.

How is chemo usually given?

Fee is common.

Very common.

Fore administration allows the drugs to get into the bloodstream quickly, but it requires good venous access, and there's a significant risk called extravasation.

That's when the drug leaks it out of the vein.

Yes, and it can be serious.

Some chemo drugs are just irritants causing inflammation, but others are vesicans.

They can cause severe tissue damage, blistering, even necrosis if they leak.

Nurses have to be incredibly vigilant monitoring IV sites.

Which is why central lines are often used.

Exactly.

Central venous access devices, or CVAids like PICC lines or ports, provide secure long -term access, reducing the risk of extravasation, and sparing peripheral veins.

Chemo can also be given orally, which is convenient, or sometimes via regional chemotherapy.

Delivering it right to the tumor area.

Intra arterial chemo for a specific limb, or intraperitoneal for ovarian cancer, or intrathecical directly into the spinal fluid for CNS involvement.

The idea is higher drug concentration at the tumor site with less systemic toxicity.

Okay, let's talk about the other major player, radiation therapy.

How is it different?

Radiation therapy is usually a local treatment, unlike systemic chemo.

It uses high -energy beams like x -rays or protons to damage the DNA of cancer cells in a specific targeted area causing them to die.

So it's aimed right at the tumor.

Correct.

There's a lot of planning involved simulation sessions using CT scans or MRIs to precisely map the tumor and surrounding healthy tissues.

The goal is to deliver a high enough dose to kill the cancer cells while minimizing damage to nearby normal organs.

Doses are carefully calculated and usually delivered in daily fractions over several weeks.

What are the main ways radiation is delivered?

The most common is external beam radiation therapy,

or EBRT.

The patient lies on a table and a machine called a linear accelerator directs the radiation beams at the tumor from outside the body.

And the other type is internal?

Yes, internal radiation, also called brachytherapy.

This involves placing radioactive sources directly into or very close to the tumor.

These can be temporary implants that are removed later or tiny permanent seeds.

That sounds like it requires special safety precautions for nurses.

Absolutely, especially with brachytherapy implants.

The principles are time, distance, and shielding.

Limit your time in the room, maintain distance from the source whenever possible, and use appropriate shielding.

Nurses caring for these patients often wear film badges to monitor their own radiation exposure, following the ALR principle as low as reasonably achievable.

Okay, managing the side effects of both chemo and radiation is a huge part of nursing care.

Let's tackle some of the big ones.

Bone marrow suppression?

Yes, myelosuppression.

Probably the most common dose -limiting side effect, especially with chemo.

It affects all blood cells produced in the bone marrow.

So low white blood cells, low platelets, low red blood cells.

Exactly.

We monitor the complete blood count, CBC, very closely.

The lowest point, the nadir, usually hits about 7 -10 days after a chemo cycle.

And the biggest concern is infection risk.

Definitely.

With neutropenia, low neutrophils, a type of white blood cell.

Neutrophils are the main defense against bacteria.

When counts are low, even a minor infection can become life -threatening very quickly.

So a fever in a neutropenic patient?

Is a medical emergency.

Temperature of 100 .4 degrees F, 38 degrees C, or higher,

needs immediate attention, assessment, cultures, and usually prompt initiation of broad -spectrum antibiotics.

Teeking meticulous hand hygiene and avoiding crowds is critical.

We also use growth factors like filbrostem to boost white cell counts.

What about low platelets, thrombocytopenia?

That means increased risk of bleeding.

We monitor for bruising, patechiae, nosebleeds.

Patients need education on avoiding injury, soft toothbrush, electric razor.

Platelet transfusions might be needed if counts drop very low, especially below 20 ,000.

And anemia, low red cells.

Anemia develops more gradually.

It causes fatigue, shortness of breath.

We might use erythropoiesis stimulating agents like epoetin alpha or darbapoetin, or give red blood cell transfusions if the patient is symptomatic.

Fatigue seems almost universal.

It's more than just being tired, isn't it?

Oh, much more.

It's often described as overwhelming, debilitating.

It has many causes.

The cancer itself, the treatment, anemia, poor sleep, emotional distress.

How can nurses help manage it?

First, assess for treatable causes like anemia or thyroid issues.

Then, teach energy conservation pacing activities, planning rest periods.

Gentle, regular exercise, believe it or not, like a daily walk, has been shown to actually reduce cancer -related fatigue.

Encourage good nutrition and hydration, too.

Let's talk GI effects.

Nausea and vomiting must be dreadful.

They can be.

We call it CINV, chemotherapy -induced nausea and vomiting.

It can happen right away, acute, or be delayed.

The key is prevention.

Antimedics before chemo.

Absolutely.

Giving anti -medic drugs before chemo starts is crucial.

Medications like ondansetron, aprepetent, dexamethasone are commonly used, often in combination.

We also need to manage anticipatory nausea, learned nausea triggered just by the thought of chemo.

Good control from the first cycle helps prevent that.

And mouth sores, mucositis, or stomatitis.

Very common and painful, especially with certain chemos and head -neck radiation.

It affects the entire lining of the mouth and throat.

Meticulous oral care is essential.

Gentle brushing.

Frequent rinsing with bland solutions like saline or baking soda salt water.

Avoid alcohol -based mouthwashes.

Pain management is key.

We also watch for and treat oral thrush, candidiasis.

This often leads to eating problems,

too.

Anorexia taste changes.

Yes.

Anorexia loss of appetite is common.

Dysjucia, altered food -tasting metallic or just bland, is also frequent.

Encourage small, frequent meals, high in protein and calories.

Nutritional supplements like Insure can help.

Sometimes a referral to a dietician is needed.

In severe cases, we might need feeding tubes or IV nutrition, PN.

What about skin changes?

Radiation causes localized skin reactions in the treatment field redness, erythema, dryness and peeling, dry desquamation, or sometimes blistering and weeping, ret desquamation.

Nursing care focuses on gentle cleansing, moisturizing, protecting from sun and irritation.

Avoid harsh soaps, lotions with perfumes or alcohol, and tight clothing.

And chemo can cause skin issues, too.

And hair loss.

Chemo can cause various skin changes, like rashes or hyperpigmentation.

Elopecia, or hair loss, is a well -known side effect of many chemo drugs.

It's usually temporary, but can be very distressing.

Scalp cooling systems might help reduce hair loss with some chemo regimens.

Connecting patients with resources like LookGoodFeelBetter programs can be really supportive.

I've heard patients talk about chemo brain.

Is that real?

It is.

It's a cognitive effect.

Some people experience mental fog, trouble concentrating, memory lapses.

It can be very frustrating.

Strategies include using planners, getting enough rest, doing brain exercises like puzzles, and trying to focus on one task at a time.

Acknowledging it and providing coping strategies is important.

Moving beyond chemo and radiation.

Immunotherapy and targeted therapy are really changing the game, aren't they?

Absolutely.

They represent a more precise approach.

Immunotherapy essentially uses the patient's own immune system to fight the cancer.

It might boost the immune response generally, or use engineered components like monoclonal antibodies, those drugs ending in MAB, to target cancer cells specifically.

And targeted therapy.

Targeted therapies go after specific molecules or pathways that are critical for cancer cell growth and survival.

Think of drugs that block a specific receptor on the cell surface, like HER2 inhibitors for certain breast cancers, or drugs that interfere with tumor blood vessel growth and your genesis inhibitors.

Because they're more specific, they often, but not always, have different side effect profiles than traditional chemo.

What are some common side effects nurses see with these newer agents?

Flu -like symptoms are very common with many immunotherapies, especially interferon's fever, chills, headache, muscle aches, fatigue.

Managing these often involves acetaminophen and hydration.

Skin rashes are common with EGFR inhibitors.

Other potential side effects can include things like thyroid problems, inflammation of organs like colitis or pneumonitis, and sometimes cardiovascular issues.

Vigilant assessment is crucial.

Let's briefly mention HSCT hematopoietic stem cell transplantation.

What's the core idea?

HSCT, often called bone marrow transplant, is essentially a way to allow for very high doses of chemo and or radiation.

These high doses wipe out the patient's bone marrow, but hopefully also the cancer.

Then, healthy stem cells are infused to rescue the bone marrow and restore blood cell production.

Where do the stem cells come from?

They can be allogeneic from a matched donor, family member or unrelated, or autologous, the patient's own stem cells harvested before the high -dose therapy.

A major risk with allogeneic transplants is graft versus host disease, GVHD, where the donor immune cells attack the patient's tissues.

Okay, besides treatment side effects, the cancer itself can cause serious complications.

What should nurses be watching for?

Nutrition problems are huge malnutrition, and that severe wasting syndrome called cancer cachexia, which is really hard to reverse.

Infection remains the leading cause of death for cancer patients, often due to neutropenia or the tumor itself compromising defenses.

And that neutropenic fever alert is critical.

Absolutely.

Temperature 100 .4 degrees F, 38 degrees C, and a neutropenic patient is an emergency.

Call the provider immediately.

And specific oncologic emergencies.

Yes, these are life -threatening.

Things like superior vena cava syndrome, SVCS, where a tumor blocks the large vein draining the head and arms, causing facial swelling, distended neck veins.

Very distinctive.

Also, spinal cord compression from a tumor pressing on the spinal cord causes back pain, weakness, potential paralysis,

needs urgent treatment.

And metabolic emergencies like tumor lysis syndrome, TLS, where a rapid cell breakdown after treatment releases electrolytes like potassium and phosphate causing kidney injury and heart problems.

Hypercalcemia is another one.

Nurses need to recognize the signs early.

Let's talk about pain.

Cancer pain is incredibly common, but often undertreated.

Sadly, yes.

The biggest barrier is often inadequate pain assessment.

As a nurse, your job starts with believing the patient's report of pain.

Use a standard scale, 010.

Ask about quality, location, duration, what makes it better or worse.

Don't rely on vital signs to gauge chronic pain.

How is it typically managed?

Usually a multimodal approach.

NSAIDs, opioids like morphine or fentanyl, and adjuvant drugs like antidepressants or anticonvulsants for nerve pain.

The key is often scheduled, around the clock dosing to manage persistent pain, with additional, as needed, doses for breakthrough pain.

Oral route is preferred, if possible.

And addressing fears about addiction.

Crucial.

We need to educate patients and families that addiction is very rare when opioids are used appropriately for cancer pain.

Tolerance might develop, meaning higher doses are needed, but that's different from addiction.

Undertreatment of pain causes needless suffering.

We also incorporate non -drug methods like relaxation or imagery.

This all takes such a huge emotional toll.

How do we support patients psychologically?

It's immense.

Patients face fears of dependency, loss of control, body image changes, financial strain, relationship stress, and fear of death.

Your presence, your willingness to listen without judgment is incredibly powerful.

So being available, showing you care.

Yes.

Build trust.

Use therapeutic touch appropriately.

Provide clear, accurate information, but also help them maintain hope.

Hope can shift.

Maybe it's hope for a cure initially, then hope for good symptom control, or hope for quality time with family.

Help them set realistic goals and maintain parts of their normal life, if possible.

And don't forget the caregivers they need support, too.

And for older adults with cancer, any special considerations?

Definitely.

Cancer is more common with age.

We need to assess their functional status, comorbidities, support systems.

Age alone shouldn't determine treatment eligibility, but we need to consider how treatment might impact their overall health and quality of life.

We also have a growing population of cancer survivors now.

What are their unique needs?

Yes.

Over 16 .9 million in the US.

Survivorship isn't just about being disease -free.

Many face long -term or late effects of treatment.

Physical issues like fatigue or neuropathy, emotional challenges, financial worries, fear of recurrence.

They also have higher risks for other chronic conditions.

So the nurse's role continues long after treatment ends.

Providing a survivorship care plan, summarizing their treatment, outlining risks and follow -up schedules, teaching about potential late effects, promoting healthy lifestyles, nutrition, exercise, screenings, assessing for psychosocial needs, connecting them to resources.

We need to remember the disparities in cancer outcomes, too, right?

Social determinants of health.

A critical point.

We see significant disparities.

Black individuals and other minority populations often have higher incidents and death rates for many cancers.

Factors like poverty, lack of access to quality care, mistrust and comorbidities play a role.

Cancer is often diagnosed later in these groups.

As nurses, we must be advocates for equitable care.

Wow.

We have covered so much ground today.

A true deep dive into cancer from the cellular level right through to survivorship and the vital role nurses play every step of the way.

We really have, from understanding the biology, the development, the body's fight, to navigating the complexities of diagnosis, treatment, side effect management and psychosocial support.

Your role as a nurse is just woven through every single aspect of this journey.

It truly is.

So, as you move forward in your studies and into your nursing career, here's something to think about.

How will this deeper understanding of cancer's huge impact empower you?

Not just to treat the disease in the chart, but to truly connect with and care for the whole person who is living with cancer.

Understanding their fears, supporting their hopes and navigating their unique personal journey alongside them.

That's the heart of oncology nursing.

Thank you so much for joining us on the deep dive.

We really hope this exploration of Lewis Chapter 16 has brought some clarity and maybe boosted your confidence as you prepare to make such a meaningful difference for patients with cancer.

Keep learning.

Keep asking those critical questions and keep exploring.

Absolutely.

Until next time.