Symptom Management


The present case study aims at providing a written record of the healthcare services that I provided to the patients during my practice. A cohort study was carried out to identify a chronic illness in the patient. The current paper aims at enhancing the reader’s knowledge regarding the importance of the healthcare and nursing process as well as creates space for discussion to occur at any stage. The paper will begin by presenting a description of the patient and a rationale will also be provided for the purpose of selecting such a chronic illness. Furthermore, the care given to the patient will also be discussed using the characteristics of the nursing procedure as an edifice while addressing the ethical considerations associated with the treatment of the patient. The study presents a systematic view of the chronic illness that was diagnosed in the patient while also highlighting the outcome of the treatment that was provided to the patient.

Breast cancer is an illness that is characterized by the cells that are present in the breasts which become abnormal and increase in number irrepressibly. The end result of all the cells multiplying in the breast forms a cluster which takes the shape of a tumor. Breast cancer is therefore, a severe disease that needs to be treated immediately. If the tumor is left untreated then it spreads to the rest of the body and harms other organs. This process is referred to as metastasis. The research shows that breast cancer has varying types and each type is identified from the presence of cells that are found in the breast and which become malignant. It has been observed that hormones also play a crucial role in the development of some types of breast cancer (Colditz, Egan, & Stampfer, 1993). The study on the patient showed that cancer patients more than often exhibit cluster symptoms and these symptoms are known to foretell variations in the patient function, as well as the failure of treatment and the post-therapeutic results (Huy, Schmidt, Vrieling, Chang-Claude, & Steindorf, 2012). Symptom clusters are commonly known as two or more coexisting symptoms that might be related to each other or might have been caused due to a different cause (Fan, Filipczak, & Chow, 2007). A most common sign of breast cancer is the formation of a lump or mass. The lump or mass can either be hard and painless while other lumps in the breast are said to be soft. Most lumps can be painful too, which is why seeking professional health care assistance to have the changes in the breast checked (Liu et al., 2009). However, it should be noted that the notion of symptom clusters is considerably new in symptom management cases of cancer patients (So et al., 2009).

During the observation process of the patient, one symptom that was most commonly reported in patients diagnosed with breast cancer was fatigue (Dodd, Miaskowski, & Paul, 2001). Fatigue is defined as a feeling of exhaustion or the urge to rest due to the lack of energy. Fatigue is known to have been caused by poor sleep or sleeplessness and is mostly caused by medical procedures such as chemotherapy.

I conducted a literature search from different databases such as PubMed, PsycINFO and EMBASE to identify the researchers related to symptom clusters found in cancer patients. The search was not restricted to any specific date or year and therefore, the literature covered the research over the years till the present time. However, the research was restricted to the publications that were in English language only. In order to carry out the search, keywords like “symptom cluster”, “multiple symptoms” were joined with “breast cancer” and various results showed up which were quite helpful for my study. The search showed a total of 115 articles in which abstracts, publications and editorials were reviewed, most of which were relevant to my work and some of those articles fit the framework of my research. However, few articles were used that matched my work.
Purpose of Analysis

The purpose of this research was to determine the chronic illness and to determine the relationship between the symptoms with that of the symptom cluster. Through the research, I was able to analyze the pre-treatment symptoms in breast cancer patients along with the changes that occurred in the patients after undergoing treatment. While there has been extensive research conducted on breast cancer patients, little research has been done on the relation of a symptom with symptom cluster. It was noticed that quality of life for breast cancer patients after treatment becomes crucial as the amount of long-term survivors increases. The research aimed at examining fatigue after the patients had undergone treatment for breast cancer. Fatigue is one of the main symptoms that the breast cancer patients complain about (Victoria Mock, 2004). Fatigue can be explained as a subjective experience which affects every individual. Looking at it from the perspective of a healthy individual, fatigue is a positive response as it shows that the person needs time to rest and maintain a balance between rest and work. However, when looking at fatigue in breast cancer patients, it should be noted fatigue is one of the major worrying sign during the treatment that is provided to the breast cancer patients and also in the advanced stages of this illness (V. Mock et al., 2000). Studies that were carried most recently showed that the breast cancer patients complained about being frequently fatigued even after the treatment had ended (Portenoy & Itri, 1999). In addition to this, breast cancer patients who had been treated for their illness with the treatment period being long over still reported about suffering from severe fatigue (Abrahams et al., 2016).

It was also reported that fatigue in cancer patients was caused by lack of sleep and exhaustion from the treatment for breast cancer. Physical activity, as well as the functional impairment, was found to be prevalent in patients who were severely fatigued. In addition to this, the severely fatigued breast cancer patients reported having reduced sense of control in relation to their fatigue complaints as well as psychological problems as a result of the fatigue (Servaes, Verhagen, & Bleijenberg, 2002). The result highlighted that sleeplessness, physical inactivity and psychological attributions were largely due to fatigue. Fatigue is a severe problem found in at least 40% of the survivors of breast cancer disease. The factors that were contributing to this fatigue were physical, mental, social and behavioural factors.

Despite the efforts to advance the research outcomes into clinical practice, the research implications are faced with a multitude of problems. It has been reported that the cancer patients after treatment, experience a shift from continuous medical appointments to a long-term focus on the promotion of health and surveillance that is centred at minimizing the risk and monitoring the cancer recurrence in the patient. It has also been observed that some of the breast cancer patients are bound to have increased rates of adjuvant management underuse. Breast cancer being one of the most frequently occurring chronic illness has been the cause of death in women. In addition to this, researchers have assessed the symptoms of breast cancer and come to the conclusion that black women are less prone to having this illness, unlike the white women who have been reported to have been frequently diagnosed with breast cancer. An important factor related to breast cancer treatment is the coordination between the doctors, surgeons and the oncologists. Most often patients are recommended treatment for which care is not provided which highlights the failure of the system. System failures have been found in abundance in hospitals that treat minority women. Financial uncertainty is also one of the causes of concern for the professional experts while treating the minority women (Graells-Sans, Serral, Puigpinós-Riera, & Grupo Cohort DAMA, 2018).
Case Study

During my nursing period, I had a patient by the name of Katherine who was 39 years old at the time I was carrying out my research on breast cancer symptoms. Katherine was put under study since she first came for professional help. The research was carried on for about a year from the initial stage when the chronic illness had been diagnosed till after the treatment was over to read the different changes that occurred in the patient pre and post-treatment. The patient was referred for imaging process and was further assessed after the mammography procedure showed an unusual result. The diagnostic tool that was used was mammography which was used after the patient complained about lumps in the breast (Wolfe, 1976). When looking further into the patient’s family history for any signs of breast cancer patients or survivors, the results came out in negative which proved that the patient’s family record was clear of the disease being passed on genetically. The patient showed symptoms such as fatigue, anxiety and depression while undergoing treatment for her breast cancer. In addition to this, the patient was given breast-conserving surgery and the tumour was identified to be at stage 1.

However, the treatment was not successful as the patient returned and complained about pain in the left breast which showed that a tumour had recurred. Treatment was further provided to Katherine which included chemotherapy to completely eradicate a tumour and any cancerous cells that might be present in the patient’s breast. After the treatment was over, Katherine returned and complained about being overly exhausted and fatigued which was one of the consequences of having undergone chemotherapy. Aside from this, Katherine complained about not being to work at all due to the fatigue which had become severe even though it had been many months since the treatment. It should be noted that fatigue in breast cancer patients can be caused by different types of therapies that are involved during the treatment phase. These therapies include chemotherapy, radiation therapy, and combination therapy. It has also observed that the cancerous cells rely on the nutrients and their reliance leads towards the nutrient’s depletion in the body. Fatigue is followed by weight loss and the lack of appetite in the patient which becomes a cause of severe exhaustion as the patient does not have sufficient energy to move.

In order to prevent fatigue in breast cancer patients after treatment, various factors should be looked at so that proper solutions can be provided. For instance, when a patient undergoes chemotherapy, her blood count reduces in number leading to the patient feeling lazy and unable to do anything (McAlearney et al., 2016). Fatigue can be taken care of by spotting the signs such as tiredness and stiffness in the body along with lack of energy and the inability to focus. Including activities in the routine while keeping a balanced rest and work schedule will keep the patient from feeling exhausted. Increased rest durations in the daily routine will help in conserving the energy and will prevent dizziness and exhaustion. Increased intake of food also helps in combating fatigue as it enhances the number of calories which are a cause of energy (Wu et al., 2015). By following these prevention strategies, the breast cancer patients will be able to recover quicker than has been most often reported in such cases.

Abrahams, H. J. G., Gielissen, M. F. M., Schmits, I. C., Verhagen, C. a. H. H. V. M., Rovers, M. M., & Knoop, H. (2016). Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Annals of Oncology, 27(6), 965–974. doi:10.1093/annonc/mdw099

Colditz, G. A., Egan, K. M., & Stampfer, M. J. (1993). Hormone replacement therapy and risk of breast cancer: results from epidemiologic studies. American Journal of Obstetrics and Gynecology, 168(5), 1473–1480.

Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. In Oncology nursing forum (Vol. 28).

Fan, G., Filipczak, L., & Chow, E. (2007). Symptom clusters in cancer patients: a review of the literature. Current Oncology, 14(5), 173.

Graells-Sans, A., Serral, G., Puigpinós-Riera, R., & Grupo Cohort DAMA. (2018). Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort). Cancer Epidemiology, 54, 38–47. doi:10.1016/j.canep.2018.03.007

Huy, C., Schmidt, M. E., Vrieling, A., Chang-Claude, J., & Steindorf, K. (2012). Physical activity in a German breast cancer patient cohort: one-year trends and characteristics associated with a change in activity level. European Journal of Cancer, 48(3), 297–304.

Liu, L., Fiorentino, L., Natarajan, L., Parker, B. A., Mills, P. J., Sadler, G. R., … Ancoli-Israel, S. (2009). Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psycho-Oncology, 18(2), 187–194.

McAlearney, A. S., Murray, K., Sieck, C., Lin, J. J., Bellacera, B., & Bickell, N. A. (2016). The Challenge of Improving Breast Cancer Care Coordination in Safety Net Hospitals: Barriers, Facilitators, and Opportunities. Medical Care, 54(2), 147.

Mock, V., Atkinson, A., Barsevick, A., Cella, D., Cimprich, B., Cleveland, C., … Stahl, C. (2000). NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park, N.Y.), 14(11A), 151–161.

Mock, Victoria. (2004). Evidence-Based Treatment for Cancer-Related Fatigue. JNCI Monographs, 2004(32), 112–118. doi:10.1093/jncimonographs/lgh025

Portenoy, R. K., & Itri, L. M. (1999). Cancer-Related Fatigue: Guidelines for Evaluation and Management. The Oncologist, 4(1), 1–10.

Servaes, P., Verhagen, S., & Bleijenberg, G. (2002). Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Annals of Oncology, 13(4), 589–598. doi:10.1093/annonc/mdf082

So, W. K., Marsh, G., Ling, W. M., Leung, F. Y., Lo, J. C., Yeung, M., & Li, G. K. (2009). The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. In Oncology nursing forum (Vol. 36).

Wolfe, J. N. (1976). The risk for breast cancer development determined by the mammographic parenchymal pattern. Cancer, 37(5), 2486-2492.

Wu, Y. P., Yi, J., McClellan, J., Kim, J., Tian, T., Grahmann, B., … Wright, J. (2015). Barriers and facilitators to healthy diet and exercise among adolescent and young adult cancer survivors: implications for behavioural interventions. Journal of Adolescent and Young Adult Oncology, 4(4), 184–191.

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