Cancer Assessment and Interventions

Older adults have an increased risk of malignancy (Howlader et al., 2018). Seniors often tolerate cancer treatment as well as younger people, depending on functional and general health status (Droz et al., 2017; Gomez-Millan, 2009; Sastre et al. 2008, Wildiers et al., 2007).

BACKGROUND

Cancer is most often diagnosed in people aged 65 years and over (Howlader et al., 2018). Nurses must be aware of management options and some potential emergencies associated with the diagnosis and treatment of a malignancy.

PRINCIPLES OF CANCER CARE IN THE OLDER PERSON

A.  Assessment of comorbid conditions

  1. Cancer may be one of several chronic conditions.
  2. The more severe the comorbidity, the lower the probability of survival after a diagnosis of cancer (Iversen et al., 2009). The absence of severe comorbidity and good general health allows older people to be considered for more aggressive types of cancer treatments (Banysch et al., 2018; Vitale et al., 2019).

B.  Assess the patient using a comprehensive geriatric assessment.

  1. The CGA is a battery of clinical measures used to assess functional, emotional, and cognitive status; falls; medications; and general health status (Overcash, 2018; Wildiers et al., 2014).
  2. Functional status can be measured using an Activity of Daily Living Scale (Katz et al., 1970), Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969), Gait Assessment Scale (Tinetti, 1986), or Berg Balance Scale (Berg et al., 1992).
  3. Risk of falls can be assessed using the Timed Up and Go Test (Podsiadlo & Richardson, 1991).
  4. Emotional status is often assessed using the Geriatric Depression Scale (Yesavage et al., 1982).
  5. Cognitive status is assessed using the Mini-Cog (Borson et al., 2000).
  6. General health status is assessed with a complete history and physical exam.
  7. Medication is evaluated using the Beers Medication Screen (AGS, 2019).

C.  Assessment of medical emergencies associated with cancer

  1. Hypercalcemia
    • Defined as calcium concentrations greater than 10.2 mg/mL (C. T. Lee et al., 2006)
    • Signs and symptoms are not often noticeable.
    • Gastrointestinal discomfort, lethargy, confusion, anorexia, nausea, constipation, polyuria, and polydipsia are symptoms (Halfdanarson et al., 2006).
    • Treatment depends on severity.
    • Thiazide diuretics should be discontinued.
    • Hydration with intravenous normal saline is recommended.
    • Bisphosphonates are an option (Fallah-Rad & Morton, 2013).
  2. Tumor lysis syndrome (TLS)
    • Caused when a tumor breaks down rapidly (Wagner & Arora, 2014).
    • Causes hyperkalemia, hyperuricemia, and hyperphosphatemia, which can cause renal failure and reduced cardiac function.
    • Signs and symptoms are muscle cramps, anxiety, depression, confusion, hallucinations, cardiac arrhythmia, and seizures (Cantril & Haylock, 2004; Dubbs, 2018).
    • Treatment with hydration, administration of allopurinol, and diuresis are generally the first line of treatment (Cantril & Haylock, 2004).
    • Treatment with rasburicase has been found to be effective in the treatment and prevention of hyperuricemia and TLS (Dinnel et al., 2015).
  3. Spinal cord compression
    • Occurs when metastasis spreads to the vertebral bodies and invades the spinal cord (Campillo-Recio et al., 2019; Halfdanarson et al., 2006).
    • Signs and symptoms are numbness, tingling, and weakness in the extremities; sensory changes; upper thorax and back pain (Lowey, 2006; Tsukada et al., 2015).
    • Pain can radiate or localize and may seem chronic, which may disguise the emergent spinal cord compression and delay critical treatment.
    • Bowel and bladder dysfunction can also occur (Tsukada et al., 2015).
    • Treatment is often initiated with glucocorticoids, followed by radiation therapy and/or surgery (George et al., 2008).
  4. Neutropenia fever
    • Caused by the diminishment of neutrophils by chemotherapeutic agents
    • Neutropenia is defined by an oral temperature of 101°F and an ANC of less than1,500 cells/μL. An ANC of less than 500 cells/μL is considered severe (Freifeld et al., 2011).
    • Generally, fever is the presenting sign; however, skin rashes and mucositis may also be present.
    • Prevention of neutropenia and neutropenic fever should be proactive in the administration of G-CSFs in patients who are considered to be at high risk (Aapro et al., 2011; Dale, 2016).
    • Treatment of neutropenia is to stop chemotherapy until white counts elevate.

PARAMETERS OF ASSESSMENT

A.  Older patients with cancer require comprehensive geriatric assessment and monitoring during diagnosis and treatment of malignancy.

ABBREVIATIONS

ANC         Absolute neutrophil count

CGA         Comprehensive geriatric assessment

G-CSF       Granulocyte-colony stimulating factor

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Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti PhD, RN, FAAN, E., Zwicker DrNP, APRN, BC, D., & Fulmer PhD, RN, FAAN, T. T. (2020). Evidence-Based Geriatric Nursing Protocols for Best Practice (6th ed.). Springer Publishing. Retrieved November 4, 2020, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826188144.html#description

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