Case study: Depression of patient with metastatic non-small cell lung cancer and palliative care
FadiFawares
Rabe'e Haddad
Faculty of Nursing
The University of Jordan
May 2015
Supervised by:
Dr. Amani Khalil Case study: Depression of patient with metastatic non-small cell lung cancer and palliative care
Introduction:
Lung cancer is one of the most popular type of cancer that cause of cancer-related death in the world, and most common with female rather than male. (cancer.org.2014) There are two major types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) (cancer.org.2014).
Providing palliative care parallel with cancer directed care appears to patients at the first time of diagnosis (Temel et al ,2010). Early, The main aim of palliative care is to increase comfort and improve QOL, and to control mood changes .
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Palliative care can provide relief and improve quality of life at all stages of cancer diagnosis and treatment (temel, et al 2007). Palliative care covers the management of a broad range of issues, from physical and psychological problems to social and spiritual issues. Pain relief and help for shortness of breath are often important targets in palliative care for lung cancer, but there may also be treatments for anxiety, nausea and other physical symptoms. Breathlessness will be treated with oxygen and medication such as opioids. anxiety-relieving drugs, and sometimes high-dose steroids. A tube may be put into the chest to drain off excessive fluid if this is causing the breathlessness, while laser treatments may be used to open blocked airways. Physiotherapy can help with breathing techniques and
Lung cancer is the most commonly diagnosed cancer in the world, according to the World Health Organisation. In the UK, it 's the second most-frequently occurring cancer among men (after prostate cancer), accounting for 1 in 7 new cases, and the third most-frequently diagnosed cancer in women (after breast and bowel cancer) accounting for about 1 in 9 new cases. However, numbers have dropped considerably in recent times, by about 16% in the last decade alone.
Palliative care is a holistic approach to support a patients symptoms who have an advanced progressive condition. Healthcare professional’s objectives are for the patient and families to have the best quality of life throughout their illness, this also involves psychological, social and spiritual support (NCPC, 2015).
Lung cancer is the most common cancer-related cause of death among men and women. Lung cancer can be undetected for many years causing it to become more dangerous and possibly fatal. There is not cure for lung cancer or any cancer, but if detected in an early stage the lung cancer can be detected, treated, and hopefully terminated. There are many new and developing treatments being tested now that may save lives in the future. Through understanding what the lung cancer is, doctors can easily diagnose and assess cancer patients.
According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues
Lung Cancer, like any other type of cancer, is the uncontrollable growth of cells in the lung tissue. The main causes that contribute to lung cancer include inhaling carcinogens (basically, smoking), exposure to ionizing radiation, viral infections and even air pollution. These factors basically damage the tissues lining the bronchi in the lung, leading the cancer to develop further (Vaporciyan & Nesbitt JC, 2000). Primary lung cancers that develop in the epithelial tissues of the lung are known as carcinomas and claim the top spot in terms of leading cancer-related death causes. As of 2004, lung cancer
Lung Cancer is a disease which consists of uncontrolled cell growth in lung tissues. Lung cancer consists of two types, Non-small cell lung cancer, and small cell lung cancer. (NSCLC) is the most common type of lung cancer. The bronchi are the large air tubes leading from the trachea to the lungs that convey air to and from the lungs, and where most lung cancers begin. The body normally maintains cell growth only
Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.Palliative care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Cellular / Molecular Basis: Lung cancer has two types; small cell and non small cell. The two types can be identified by their appearance when looked at with a microscope. It usually affects the cells that are lined along air passages in the lungs.
Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).
Squamous Cell Non-Small Cell Lung Cancer (NSCLC) occurs in about 30% of all Non-Small Cell Lung Cancer cases. (Khan Academy Medicine, 2012) There are two main features of squamous cell NSCLC that distinguish it from adenocarcinoma and large cell NSCLC. Squamous cells contain keratin within the cell and are connected to each other by desmosomes (Khan Academy Medicine, 2012). Squamous cell NSCLC is most commonly found in male smokers who have a cough, airway obstruction, Hilar-adenopathy, mediastinal widening with chest x-rays, and Hypercalcemia (Harold, J. Bruyere, 2009).
Palliative care may provide support for the individual’s social support network. While palliative care is often offered as end-of-life care, it may also be offered during any serious illness to ease the burden of that illness, whether or not that illness is considered terminal. (“Palliative Care” 1)
The team that provides this service are all highly trained medical professionals that include physicians, nurses, patient care technicians, counselors, and chaplains to offer support. Studies have shown that palliative care is effective in relieving pain and symptom distress with expert precision. It also helps with difficult decision making, reduces confusion, anxiety and stress for the patient and family. Palliative also supports the family in their care giving role, offering advice, instruction, and referral services. (Baycare,
Palliative care can overlap with life-sustaining approaches to a terminal illness and often palliative care is offered in conjunction with other medical treatments (Billings & Pantilat, 2001; Morrison & Meier, 2004). Palliative care is not curative, the intent is to provide relief from symptoms (both physical and emotional)(Kuziemsky, Jahnke, & Lau, 2006). Many treatments overlap between the palliative and curative models and these disciplines are synergistically linked (Table 1).
I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of
Palliative care teams help treat people suffering from the symptoms and stress of serious illnesses such as cancer, congestive heart failure, chronic obstructive pulmonary disease,kidney, disease, Alzheimer's, Parkinson's, and many more. Symptoms of patients submitting to palliative care many include depression, pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and much more (Get palliative care organization).