Nursing care and symptom management in lung cancer treatment

Lung Cancer

Research in gene therapy and improvements in radiation therapy have provided a new ray of hope for lung cancer patients. Management of symptoms and improving the quality of life is one of the most important features of cancer care and the cancer nurse plays a large role in this by providing proactive and treatment centric nursing interventions for symptoms palliation.

Lung cancer is one of the most lethal diseases in the United States with more deaths compared with any other form of cancer. With 160,390 deaths in 2007, lung cancer represents the single most threatening form of the disease exceeding causalities for breast cancer, colon cancer and prostrate cancer put together. [CDC] in England, lung cancer accounts for 5% of all deaths every year. [Wake B.L] Patients with lung cancer also present with higher levels of symptom distress compared with other forms of cancer. Further, lung cancer patients also experience multiple symptoms, which vary with different treatment modalities. Poor symptoms management not only leaves the patient severely dysfunctional but also psychologically distressed. [MARY E. COOLEY et.al, 2003] New developments in cancer treatment such as gene therapy and radiotherapy also impact care provision. Providing Symptoms management is a vital aspect and oncology nurses have a large role to play in alleviating the distress of the patients. Let us briefly examine the new developments in cancer care with the impacts on the professional practice of the cancer care nurse.

Genetic and Molecular Biology of cancer

Our understanding of cancer has advanced much over the last two decades. Researchers have made great strides in the study of the genetic and the molecular biology of cancer. The genetic abnormalities that lead to cancer are more clearly illustrated by the vast amount of research conducted on colorectal carcinoma. It has been found that the genetic precursors for cancer include suppression of the tumor suppression gene APC leading to the transformation of the normal somatic cell into an adenomatous polyp. This is followed by mutations in other tumor suppression genes such as P53, DCC and K-Ras resulting in the formation of adenoma with a great propensity for developing into carcinoma. [Caldas, C, 1998] Most cases of cancer are caused by loss of cell regulation due to suppression of P53 or abnormalities in P53 gene affecting natural cellular apoptosis leading to uncontrolled proliferation of cancer cells. [Richard C. Duke, 1996]

Some of the genes like: PTEN/MMAC1, DMBT1 (deleted in malignant brain tumor-1), EGFR, TP53, P16, PDGFR, are implicated in lung cancer and brain tumors. Today, though we know about the alterations in these genes, we are yet without a clue as to the cause for these abnormal gene alterations. Several studies have revealed that P53 mutations are the most common among humans and therefore carry a high risk potential for developing cancers. Since the P53 gene is directly responsible for cell cycle regulation, including the initiation of apoptosis, aberration in the gene results in uncontrolled cell growth.[Nobuaki Ishii] Other studies have shown that the P. I3 kinase (phosphoinositide-3-kinase has an important role in regulating the number and size of the cells. [Karen T. Barker, 2003] a recent study by Massion et. al (2004) also observed a distinct increase in PIK3CA in 70% of squamous carcinomas and in 38% of large cell carcinomas. [Massion et.al, 2004] Thus, APC gene, p53, Ras and several other biological markers have already been identified and are currently the focus of the development of more effective pharmacogenetic interventions. [HEIKE ALLGAYER, 2003]

Lung Cancer Treatment Methods

There are a variety of treatment methods for lung cancer including, Surgery, radiotherapy, chemotherapy, Photodynamic therapy, gene therapy, etc. While chemotherapy and radiation therapy are traditional, they have not proved to be totally effective. The rapid advancements in gene therapy seem to offer a new ray of hope for lung cancer patients. One of the successful pilot studies was conducted by Dr. David P. Carbone, Phd, in early 2000. The primary purpose of this gene therapy was to trigger the expression of P53 and to suppress the oncogenes by injecting normal genes into the cancerous cells using recombinant adenovirus as a vector. This trial was administered on patients with bronchioloalveolar lung carcinoma, a condition which is typically non-responsive to radiation and chemotherapy. Four of the 11 subjects showed considerable improvements in symptoms management and four out of 9 subjects who were evaluated for DLCO showed 20% increase in gaseous absorption (from air into blood). [ACS]

More recently gene therapy has focused on chaperone heat shock protein 90 (HSP90), which is responsible in several cellular signaling mechanisms for a number of oncogenic client proteins such as ERBB2, C-RAF, CDK4, AKT/PKB, mutant P53 etc. Thus, by targeting and modulating the HSP90 it is possible to inhibit the development of malignant phenotypes. Successful clinical trials have been reported for drugs such as geldanamycin analogue and 17-allylamino-17-demethoxygeldanamycin offering a new promise for cancer patients. The development of effective HSP90 inhibitors is currently the focus of pharmacogentic researchers. [Marissa V Powers]

The downside of gene therapy is that it is still a new therapy and in most cases in the trial phase in which patients willingly consent after being informed of the potential risk factors. Research nurses have an important role to play in identifying appropriate candidates for gene therapy in consultation with the doctor and in constant monitoring of the patients for any abnormal reactions to gene therapy. Also, since some of the adverse effects may not manifest immediately, nurses who care for patients who underwent gene therapy have to be aware of the possible immediate side effects and the management of long-term effects, which may not be listed within the gene therapy protocol at the time of the therapy. Oncology nurses have to educate the patients and their families as to the potentials of gene therapy, train other nursing staff and also participate in the research programs for gene therapy as they have the first hand information about patients reaction to genetic therapy. Since gene therapy is very much in the trial phase now, cancer nurses have a significant role in terms of their valuable input into research, as they are the direct caregivers for patients in clinical trials. [Connie Henke Yarbro, 572]

Conclusion

Symptoms management is most important for lung cancer patients. Asides the multiple symptoms associated with lung cancer, new symptoms also develop with respect to the nature of treatment. Providing ventilatory care, anemia care, and pain management are some of the common symptomatic interventions on the part of the nurse. Thus, continuous monitoring of symptoms is necessary during the course of the treatment in order to provide more effective clinical interventions for better symptoms management. From the cancer nursing perspective the integration of therapy and symptoms management is most important to provide vital relief for patients. New therapies based on the specific biological process of lung cancer are being developed. Cancer nurses with sufficient knowledge of the biological basis of these therapies would be better equipped to deal with the practical clinical implications and provide better symptoms management. The technical understanding of the nurses is also crucial in educating and in enabling the patients to take care of themselves. Further, it also goes without saying that nurses, as the primary caregivers are responsible for the emotional well being of the patients. Improving the quality of life is one of the most important features of cancer care and the cancer nurse plays a large role in this by providing proactive and treatment centric nursing interventions for symptoms palliation.