Care of the Patient with Cancer

Core Concepts

Treatment modalities at a glance

• Surgery removes the tumor — often curative for localized disease; also used for biopsy, staging, debulking, palliation.
• Radiation therapy damages DNA in the target field — external beam or internal (brachytherapy).
• Chemotherapy uses drugs that interfere with cell division. Because it cannot distinguish cancer cells from healthy dividing cells, it also damages the most actively dividing tissues — marrow, mouth and gut lining, hair follicles. That trade-off explains most chemotherapy side effects.
• Targeted therapy, immunotherapy, and hormone therapy attack specific molecules, harness the immune system, or block fuel hormones (some breast and prostate cancers) — more selective, each with its own side effects.
• Stem cell transplant replaces treatment-damaged marrow with healthy blood-forming cells — high-risk, with specialized nursing care.

The treatment plan is a shared decision between the person and the oncology team; the nurse educates, coordinates, and advocates.

Chemotherapy safety: protecting the patient and the nurse

Chemotherapy is administered by trained professionals under strict verification — correct drug, dose, route, time, patient, and consent. Because many chemotherapy drugs are hazardous drugs, handling follows institutional policy and national standards (e.g., in the U.S., NIOSH hazardous-drug guidance and USP general chapter on hazardous drug handling): controlled preparation, protective equipment (gloves, gowns, eye protection), safe transport, designated disposal. The nurse follows the institution's hazardous-drug policy to the letter — shortcuts are never acceptable. Extravasation (leakage of a vesicant drug into surrounding tissue) is a serious, protocol-driven emergency — so IV access is verified before and during infusion.

Radiation safety: time, distance, shielding

External-beam radiation leaves the patient with no residual radioactivity — the "radioactive patient" precautions apply mainly to brachytherapy and certain systemic radioactive treatments. For internal sources, the safety triad is time, distance, and shielding: limit time near the source, maximize distance, use shielding. Brachytherapy care follows strict institutional protocols — visitor restrictions, staff time limits, shielding, work reassignment for pregnant staff. Skin in the field may redden, dry, or irritate; the nurse protects it from friction, sun, and harsh products per the radiation team's guidance.

Common side effects and nursing care principles

• Myelosuppression — reduced marrow production of blood cells — is the most important predictable effect: neutropenia raises infection risk, anemia causes fatigue, thrombocytopenia raises bleeding risk. Care principles: infection precautions (hand hygiene, avoiding ill visitors, prompt fever reporting), bleeding precautions, energy conservation.
• Mucositis (painful breakdown of the mouth and gut lining) — gentle oral care, soft foods, pain management, meticulous mouth assessment.
• Nausea and vomiting — usually preventable with scheduled antiemetics prescribed by the team; the nurse administers them on time, before nausea starts.
• Fatigue — the most common and underappreciated symptom; principles are energy conservation, activity balance, sleep, and honest acknowledgment that fatigue is real. Alopecia, neuropathy, and "chemo brain" each have supportive measures; the nurse teaches what to expect.
• Infection-risk education is a safety conversation: the neutropenic person must report fever immediately — fever on chemotherapy is an emergency until proven otherwise.

Oncologic emergencies: recognize and escalate

Some complications are life-threatening within hours. The nurse's job is recognition, immediate reporting, and protocol-driven response — not independent treatment. High-yield emergencies: neutropenic fever (fever in an immunosuppressed person); tumor lysis syndrome (rapid tumor-cell breakdown floods the blood with potassium, phosphate, and uric acid, overwhelming the kidneys); spinal cord compression (back pain with weakness, numbness, or bladder changes); hypercalcemia of malignancy (nausea, confusion, weakness); and superior vena cava syndrome (facial swelling, breathing difficulty). Clear escalation pathways save lives; the nurse who acts on "this doesn't feel right" triggers them.

Psychosocial, spiritual, and end-of-life care

Anxiety, depression, body-image changes, financial strain, family roles, and existential questions are all part of the illness. Nursing interventions include therapeutic communication, realistic hope (for cure or comfort), spiritual assessment and chaplaincy referral, family support, and early palliative care — appropriate at any stage, not only at the end. Person-first language ("a person with cancer") reflects the dignity at the center of this work; scope, policy, and the care team's plan govern every clinical action.

Common Confusions