Post-Conference Session Summaries

Cancer Prevention Strategies to Improve Survivor Odds

Instructional Session 17, presented Thursday, April 26

Ellen Giarelli, EdD, RN, CRNP, began this session with a discussion of the impact of the media on the public's perceptions of cancer therapies. Some of the scientific literature about cancer may seem to conflict with or run counter to the general perspectives of the media and the general public. Giarelli stated that the Prevention/Early Detection Special Interest Group, which sponsored the session, calls on all nurses to assess patients' levels of cancer prevention knowledge by monitoring their environments, keeping abreast of common perceptions and awareness in pop culture, and knowing about the proactive services and interventions available within the community.

Barb B. Carpenter, MSN, ARNP, FNP, CPON^®, AOCNP, turned the discussion to primary, secondary, and tertiary cancer prevention strategies for adults and children. Primary cancer prevention consists of maintaining a healthy lifestyle, including eating a well-balanced diet, exercising, and being aware of environmental concerns. For example, Carpenter stated that 87% of lung cancer deaths are caused by cigarette smoking. The leading environmental factor after tobacco is sun exposure. In addition, patients should be encouraged to manage their stress levels as high amounts of stress can adversely affect the immune system.

By identifying the potential risk factors for cancer, healthcare providers can affect prevention. Leukemia accounts for 23% of pediatric cases of cancer, making it the most common diagnosis. This information is very important when evaluating children, as is the fact that central nervous system neoplasms are the most common form of solid tumors in children. Researchers have also determined that x-ray exposure and postnatal exposure to high radiation doses are potential risk factors for pediatric cancers; therefore, nurses should encourage parents to avoid these procedures in children. In addition, children with Down syndrome or other genetic conditions are more prone to developing cancer.

Follow-up care is pivotal when evaluating for cancer recurrence or metastasis. Carpenter indicated that evidence-based standards of survivorship care must, at a minimum, include 11 recommendations, such as the likely recovery course from treatment toxicities and ongoing health maintenance, a description of the recommended cancer screenings and other periodic examinations, and teaching about the late and long-term effects of treatment and its symptoms.

Increased research is needed regarding personalized medicine and behavioral sciences. In its update to a 2001 progress report, the National Cancer Institute estimated that 50%–75% of all U.S. cancer deaths are caused by behaviors including smoking, physical inactivity, and poor dietary choices. In addition, patients must be informed about the flaws in cancer prevention strategies. For example, although Gardasil^® (Merck & Co., Inc.) can prevent four types of human papillomavirus, more than 100 types of the disease exist, indicating that Pap smears continue to be an important screening method.

The session's third speaker, Robin L. Coyne, RN, MSN, FNP, noted a number of chemoprevention options for breast cancer. Tamoxifen has been approved for breast cancer risk reduction in pre- and postmenopausal women, whereas approval is pending for raloxifene use in postmenopausal women. A number of assessment tools for breast cancer are currently available, but Coyne recommended the use of the Gail Model for Risk Assessment.

Nurses must advocate for quality cancer care that is accessible to all patients. Care must be timely, comprehensive, and multidisciplinary. Cancer care also should be available through systems that provide reimbursement and should be delivered by accountable professionals who possess the credentials that are appropriate to the specialty.