Cancer and Cardio Toxicity

The Case

The client is a 33-year-old advanced breast cancer patient admitted to the emergency room (ER) with cardiac arrest. She is unmarried and accompanied to the ER by her boyfriend.

Relevant Health Assessment Information

Cancer therapies are associated with a wide range of long and short-term cardio toxicity effects that affect a patient’s heart structure and function (Clark et al., 2017). However, sources advise that clinicians consider the circumstances of their patients on an individualized case-by-case basis to obtain an accurate prognosis (Curigliano et al., 2020). This calls for an assessment of a patient’s overall cardio toxicity risk score as measured by their medication-related and patient-related risk factors (Curigliano et al., 2020). Cancer patients with a history of concurrent or prior chest radiation, such as lung and breast cancer patients, are at a particularly high risk of cardio toxicity, particularly if they have preexisting heart disease (Curigliano et al., 2020).

To determine the likelihood that the client’s cardiac arrest is a result of cardio toxicity, the APN nurse would need to obtain health information on current or preexisting heart disease, Diabetes Mellitus, and hypertension (Curigliano et al., 2020). Cancer patients with a history of Diabetes Mellitus, hypertension, and heart disease are at a higher risk of experiencing cardio toxicity as a result of cancer therapies. Further, the APN would need to obtain health information on the presence of lifestyle risk factors such as obesity, alcohol consumption, smoking, and inadequate diets (Curigliano et al., 2020). Clinical trials have shown a higher risk of cardio toxicity among cancer patients who regularly consume alcohol and those who smoke cigarettes (Curigliano et al., 2020). Moreover, trials report a higher risk among cancer patients whose diets lack the five serves of fruits and vegetables per day recommended by the National Cancer Institute (Curigliano et al., 2020).

Finally, it would be appropriate for the APN to obtain information on the chemotherapy medication to which the client is exposed (Hermann et al., 2014). Certain cancer medication, including Anthracyclines, Herceptin, and Cyclophosphamide, are associated with a heightened risk of cardio toxicity among breast cancer patients, while others such as Labatinib and Imatinib pose significantly low risks (Hermann et al., 2014).

APN’s Response using Evidence-Based Practice

Evidence-based literature indicates that one’s relationship status influences their ability to lead healthy lifestyles (Schoeppe et al., 2018; Hamplova, 2018). Unmarried persons are more likely to be cigarette smokers and to consume alcohol regularly. Further, trials have shown that unmarried persons are less likely to consume healthy diets and are more likely to eat fast foods regularly (Schoeppe et al., 2018). Poor diet, cigarette smoking, and regular alcohol intake have all been shown to heighten the risk of cardio toxicity among cancer patients under treatment (Curigliano et al., 2010; Hermann et al., 2014).

The client has advanced breast cancer, which places her at a high risk of cardiac malfunction in the event of exposure to any of the above risk factors. However, she is unmarried and has her boyfriend as the primary caregiver given that he accompanies her to the emergency room. In this regard, it may be appropriate to advise the client that her current relationship arrangement increases the risk of negative health outcomes as it opens avenues for poor lifestyle choices. The APN nurse may thus recommend that the patient hires a full-time caregiver, who would help her plan her meals better and develop a fitness plan to minimize the risk of poor lifestyle choices that increase the risk of cardio toxicity related to cancer therapy. The client could interpret the APN’s advice as an infringement on privacy. However, the nurse has a professional obligation to act in line with evidence-based practice.