Thesis: Cancer Patients When They Look Better Do the Feel

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cancer Patients: When they Look Better do they fell better?

Health is not just a physical factor but a dynamic interaction of physical, psychological and social variables. For so long, there has been a huge gap between the physical care and the psychological care for cancer patients. Cancer nurses today are expected to provide a whole spectrum of services that cater to the physical, psychological and psychosocial needs. Looking good makes a cancer patient feel good and the sense of feeling good is important for a positive prognosis. This makes it easier for the patient in the whole continuum of cancer care.

Cancer is the single largest cause of death in many developed and developing countries. While cancer care has improved considerably over the last decade with the introduction of many new and potent drugs and therapies, the psychological and psychosocial aspects of the disease remain largely neglected. This discrepancy could totally compromise the quality of health care and negatively affect the outcome for cancer patients. When the underlying psychological aspects of cancer such as depression, shock, negative self-image due to treatment-induced changes in physical appearance, and the general disruption of normal life go unaddressed it can seriously impair patients' recovery. Without addressing the psychosocial health needs of the cancer patient it is not possible to provide optimal care for cancer. Oncology nurses play a vital role across the entire spectrum of care provision. In the following sections the psychosocial needs of cancer patients and how 'they feel better when they look better' will be discussed with a particular stress that the role of the cancer nurse extends beyond providing physical care, and that holistic care involves both physical, psychological and psychosocial care.

Cancer Psychosocial aspects

As mentioned above surviving cancer involves severe psychological distress including fear of recurrence, dealing with impairments to normal functioning and changes in physical appearance. Patients with unmet psychological needs may not be regular in continuing with cancer medications and are at a severe risk for a relapse. It is therefore important to treat cancer related depression and anxiety as an integral part of cancer care. The short-term and long-term side effects of cancer predisposes the patient for depression and hence oncology care givers should strive to improving the self-esteem of Cancer patients by providing comprehensive psychosocial support both during and post cancer recovery. Chemotherapy, radiation and surgical interventions such as mastectomy involve physical disfigurement causing severe distress.

Recognizing the importance of emotional needs of a cancer patient, the Personal Care Products Council Foundation initiated the 'Look Good Feel Better' program way back in 1989 supported and sponsored by the cosmetic industries in the country. The aim of this public service program is to provide an appearance makeover for cancer patients who have been affected physically by the effects of cancer treatment. This has proven to be an immensely beneficial support for women (and men as well) who are going through the rigors of cancer treatment. Sponsored by the American Cancer Society, the LGFB program is currently offered in hospitals across the entire country. Patients are provided with free cosmetic products along with expert guidance to create a new makeover for them. As Dr. Dr. Anthony Brissett, director of facial plastic and reconstructive surgery at the Baylor College of Medicine in Houston states "Often, cancer patients have significant asymmetries, imbalances, or facial paralysis following some cancer treatments,"[BCM] the after effects of chemotherapy or the effects of surgeries for breast or oral cancers shock patients sending them into a trauma. As several studies show it is this aspect of cancer care involving the psychological needs of the patient that is poorly understood. While there is as huge leap in terms of the advancements in biomedical research there has not been a corresponding increase in our understanding of the psychosocial effects of cancer.

The LGFB strives to correct this deficiency by including appearance as an important aspect of the cancer patients' treatment. Because improving the patients external appearance automatically improves his self-image and creates a sense of well being it definitely represents a holistic approach to cancer care. Oncology nurses should understand the emotional needs of the patient and helping the patient look better is an important part of care giving. As Dr. Brissett says, 'By making subtle adjustments to their hairstyle, reshaping their eyebrows, and variations in make-up application, their appearance can be significantly improved. 'It allows people to try and look their best when they feel the worst and support themselves when times are challenging for them," Also, 'It also allows them to talk amongst themselves, so it's a group therapy in and of itself as well." [BCM] the LGFG program has now expanded to more than 15 countries in the world serving millions of women helping them face the disease and its treatment with confidence. [LGFB]

Post Mastectomy

Breast cancer affects millions of women in the United States. Some of these patients have to undergo Mastectomy when other alternative methods of treatment are insufficient. Patients develop psychological fears and very low self-esteem. Most of them perceive their femininity under threat and are emotionally unstable. Under these circumstances the role of the Breast care nurses is very significant. Almost 90% of mastectomy patients opt for breast prosthesis. Robert et.al 2003 studied Women's experiences with prosthesis by organizing focus groups. It was found that relationship with the breast care nurse and prosthesis fitter affected their perception after the surgery. The researchers also found that though initially prosthesis did not feel attractive to the subjects with time they felt great improvement in body image and their feminine identity. [Robert et.al 2003]

Another more recent study pertaining to mastectomy patients undergoing transverse rectus abdominus musculocutaneous flap breast reconstruction (TRAM) served to highlight the important role of cancer nurses. Ten women who underwent TRAM procedure following mastectomy in a cancer hospital in Sydney were the subjects of this study. Five of the women involved in the study had immediate breast reconstruction while the rest had delayed reconstruction. Data was gathered using semistructured interviews. All the subjects had felt great psychological distress post mastectomy and their psychosocial needs were largely unmet. The study concluded that a more thorough understanding of the experiences of women who undergo breast reconstruction is essential to provide appropriate support and counseling. This study also highlighted that the role of oncology nurse extends far beyond providing postoperative physical care and includes psychosocial support as an integral part of the healthcare. [Hill et.al, 2008]

The whole concept behind the "Look Good...Feel Better" program is to make the whole experience of cancer and its treatment better for the patient. Feeling better improves the prognosis for the patient, as response to medical intervention is better when the patient is least distressed. Improved self-esteem has a positive influence on the patient affecting treatment and its outcome significantly. A recent Japanese study focused on the psychological distress among patients with neck and head cancer as well as the effect of preoperative self-esteem on the psychological stress during the treatment. 58 patients who were scheduled for neck or head surgeries participated in the study. The Rosenberg self-esteem scale was used prior to surgery and 6 months after surgery. The Hospital Anxiety and Depression Scale (HADS) was administered prior to surgery, after the surgery, and 6 months post operatively. Comparison of the gathered information clearly revealed that patients in the high self-esteem group showed significantly lower levels of anxiety and depression compared with the low self-esteem group. The results suggest that pre-operative psychological intervention is essential for patients with poor self-esteem. [Kobayashi et.al, 2008]

Another research by Kurtz et. al (2008) also analyzed the effect of patients' optimism and skills mastery on pain and fatigue management. This was a longitudinal study in which the subjects were interviewed at baseline, followed by a 10-week symptom control intervention program by nurses. This was followed by another interview at 10 weeks and then at 16 weeks. From the collected data the researchers concluded that patients who were more optimistic and who had mastery over the intervention program reported lesser severity of pain and with few co morbid conditions. Implications for nurses include identification and encouragement of such traits in the patient to enable them to have better quality of life during and after the treatment period. [Kurtz et. al (2008)]

Cosmetic Rehabilitation in Oral cancer

Oral cancer can cause significant disfigurement to the patient that requires some kind of cosmetic rehabilitation. This justifies the inclusion of cosmetic rehabilitation training program as part of the nursing care for oral cancer patients. A study by Huang et. al (2008) studied 44 oral cancer patients divided equally into experimental and control groups. While the experimental group received cosmetic rehabilitation training the control group simply received regular nursing care. Data was gathered from subjects in the form of questionnaires served during admission, after 6 weeks and at 12 weeks. For this purpose the researchers used the 'Multidimensional Body-Self Relations Questionnaire-Appearance Scales' (MBSRQ-as). The results showed that prior to the implementation… [END OF PREVIEW]

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