Chapter 20: Concepts of Care for Patients With Cancer

Cancer-related pathophysiology includes bone marrow invasion leading to reduced hematopoiesis, which results in anemia, thrombocytopenia, and immunosuppression, along with gastrointestinal dysfunction manifesting as cachexia, weight loss, nausea, and potential bowel obstruction. Patients frequently experience peripheral neuropathy and spinal cord compression causing sensory deficits and mobility impairment, while respiratory and cardiac complications may develop from direct tumor invasion, radiation exposure, or chemotherapy-induced cardiotoxicity. The chapter systematically addresses major treatment modalities including surgical intervention for prevention, diagnosis, curative intent, disease control, palliation, and reconstruction, with nursing responsibilities encompassing preoperative preparation, psychosocial support, infection prevention, and postoperative functional restoration. Radiation therapy destroys malignant cells through targeted energy delivery via external beam or internal brachytherapy techniques, requiring nurses to educate patients about skin integrity maintenance, fatigue management, and radiation safety protocols. Chemotherapy utilizes cytotoxic agents targeting rapidly dividing cells, with nursing practice focused on preventing extravasation injuries, managing treatment-induced mucositis, controlling nausea and vomiting, addressing chemotherapy-induced alopecia and peripheral neuropathy, and monitoring bone marrow suppression through supportive interventions including colony-stimulating factors. Emerging treatment approaches including immunotherapy and targeted molecular therapy harness immune system activation or block specific cancer pathways, necessitating nurse vigilance for immune-related adverse events such as colitis, pneumonitis, and hepatitis. The chapter addresses hormonal therapies for hormone-responsive malignancies and concludes with oncologic emergencies representing life-threatening complications requiring immediate recognition and intervention, including sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone secretion, spinal cord compression, severe hypercalcemia, superior vena cava obstruction, and tumor lysis syndrome. Nurses must demonstrate clinical acuity in identifying warning signs including fever, hemorrhage, neurological changes, and electrolyte derangements to prevent organ system failure and death.