Cancer challenges nursing science

Developments in the field of cancer are advancing at a rapid pace. This means that nursing care of cancer patients is becoming ever more complex. 
“New treatments and surgical procedures are coming, which means we also have to develop the nurses’ work in nursing science. It’s an exciting challenge,” says Carina Berterö, professor of Nursing Science with a specialisation in cancer-related diseases.

In Sweden, over one-third of the people are stricken with cancer at some time in their lives. Better means of detecting and treating cancer mean that around 65% of all patients are cured. This also results in more and more people living with the experience of cancer.

Alleviate the pain

There is an old Swedish saying, “Ont ska med ont fördrivas” (something akin to “no pain, no gain”) that Professor Berterö may still run across, but in contemporary cancer care everything possible is done to alleviate the pain. A nurse who discovers that a patient is feeling reasonably well is not satisfied with that information but rather keeps asking questions to make sure the symptoms and side effects are getting relief.

”It is the job of the nurse to find out about any pain or nausea the patient may be feeling, and what their tolerance is to different smells and if they have a tingling sensation in their arms or legs, to name just a few common side effects.”

Professor Berterö first trained as a nurse, earning a PhD in 1996 with a thesis on the care of leukaemia patients. Since then her primary area of research has been care of patients with the most common forms of cancer such as breast cancer, prostate cancer, lung cancer and colorectal cancer.

She is now supervising a PhD student who recently initiated a study on nerve damage in patients with colorectal cancer who receive cytotoxins with the addition of oxaliplatin. This is known to increase the odds of survival, but it can also cause nerve damage which leads to symptoms such as hypersensitivity to cold, numbness and tingling in hands and feet, muscle cramps, altered sense of taste and difficulty in swallowing.

“These are side effects that may be serious in the initial stages of treatment, but sometimes they come quite late. Sometimes they become permanent. But if they can be discovered at an early stage, then the cytotoxin treatment might be able to be adjusted so that the side-effects are reduced."

Document side-effects

The study is the first to look at how nerve damage due to cytotoxin treatment develops over long periods. It will document how common and how widespread the side-effects are; it will also ascertain what they are, when they occur and in what way they affect the patient’s quality of life and daily existence. The methodology is a commonly used one in nursing science research, with both measurable and qualitative data.

“In order to describe the discomfort from the patient’s point of view, we also conduct interviews where they describe their symptoms. What comprises ‘moderate’ discomfort for the individual, for example, how it affects their daily life and what it is that enables the patient to adapt to their situation in spite of everything. These are some of the questions we would like answers to.”

While a large amount of nursing science research is targeted at specific cancers, there is also an attempt to get away from organ-based thinking and to see the whole person.

“Good nursing measures must be built on an understanding of what happens both mentally and physically, not only with the patient but also the immediate family. This makes nursing care complex, requiring a broad knowledge of medical and behavioural science.

“It might seem simpler to use standard regimes for nursing care but as each individual is different, reacting differently, nursing care needs to be adapted to each individual,” says Professor Berterö.

Begin to think more positively

Her research has gradually led to looking at what happens to a person who is diagnosed with cancer and how his or her life is affected.

“Common to all cancers is that the diagnosis itself often involves a shock. The patient may often feel themselves changed as a person and a stranger to their own body. Their self-image may also be affected.”

There should normally be a nurse present at an early stage of the treatment with whom the patient can have continuity and whom they can rely on when necessary.

Common to nearly all types of cancer is also that many people who have been diagnosed with cancer begin to think more positively. This has been shown by studies aimed at the quality of life and daily experiences, not just symptoms and side-effects, for people suffering from different types of cancer.

“It may seem paradoxical when we take into account the shock that the diagnosis brings, but as a result of the treatment, many live in hope and appreciate life in a new way. They value other, perhaps simpler things and live more intensely.

Published 2013-11-25, Birgitta Weibull