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Introduction to the Oncology Care Unit

Site: EHC | Egyptian Health Council
Course: Evidence of nursing procedures for the Oncology Department
Book: Introduction to the Oncology Care Unit
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Date: Saturday, 20 June 2026, 9:38 PM

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"last update: 29 April.2025"                                                                                       تحميل الدليل

Table of contents

- Prepared by

Oncology guide

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Supervised by

Prof. Dr. Hussein Khaled, former Minister of Higher Education

 

Prepared by

Title  

Name

NO.

Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University

Dr Afaf Abdel Aziz Abdel Aziz Basal

1

Professor Of Critical Care Nursing

Prof.Dr/Zeinab Hussain Ali

2

Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University

Prof.Dr Amal Said Taha Refaie

3

Supervisor Of the Education Sector at Port Said University

Prof.Dr Amal Ahmed Khalil Morsy

4

Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University

Dr. Hanan Ahmed Al Sebaee

5

Head of central administration on secondment at MOHP

Dr Neveen ab drab al0nabi Mohamed

6

Director Of Primary Health Care Nursing Department at MOHP.

Maysa Hosny Ahmed Tammam

7

Supervisor Of Technical Education- EHA 

Nancy Alaa Eldeen Abd-Elbaset Ali

8

Supervisor Of Nursing Services Development- EHA

Sherien Mohamed Saad

9

Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University

Assist.Perof. Dr./Heba Mahmoud Mohammed

10

General manager of general administration of health institutes affairs

Dr Mai Galal Ibrahim Al-Assal

11

- Introduction to the Oncology Care Unit

Recognizing the importance of cancer as a significant health issue in Egypt and its psychological, physical, and financial burden on patients, families, and society, the Egyptian Health Council established oncology care units as appropriate centers for treating various cancer cases. These units are supervised by a comprehensive team of skilled professionals capable of monitoring subtle biological changes in patients and adeptly handling the equipment according to national and international standards

- Vision of Nursing Care in Oncology Care Units

The Egyptian Health Council aspires to elevate nursing care standards in hospitals across Egypt to meet sustainable development goals and compete effectively on both regional and international levels.



- Mission of Nursing Care in Oncology Care Units

The council is committed to ensuring quality nursing care that enhances public health, delivers evidence-based nursing services, adopts modern nursing practices, and upgrades the academic and practical levels of nurses to implement contemporary nursing and medical sciences.

- Definition of the Oncology Care Unit

The Oncology Care Unit is a comprehensive center dedicated to treating and caring for cancer patients. It is equipped to manage a wide range of primary and secondary cancers using modern therapeutic techniques. By employing a collaborative approach, it ensures patients receive care tailored to their needs by a team of experts and specialists, offering advanced diagnostic, medical, nursing, surgical, and psychological support throughout and beyond treatment.

- Components of the Oncology Care Unit

The unit consists of specialized sections:

  • Oncology Unit
  • Radiation Therapy Unit
  • Hematology and Bone Marrow Transplantation Unit
  • Pediatric Oncology Unit
  • Surgical Oncology Unit
  • Pain Management Unit

Service Units:

  • Operating Rooms and Accessories
  • Outpatient Clinics and Reception
  • Endoscopy Unit
  • Clinical Pathology Laboratory
  • Pathology Laboratory
  • Pharmacy
  • Information Systems Unit
  • Early Cancer Detection Unit
  • Physical and Psychological Rehabilitation and Pain Management Unit
  • Central Services Unit

- Objectives of the Oncology Care Unit

  • Provide comprehensive, advanced therapeutic and preventive care for all citizens.
  • Deliver health care for critical and acute oncology cases (e.g., gastrointestinal, liver, hematology, bone, bone marrow transplants).
  • Enhance the educational level of health care providers in various oncology treatment methods and preventive care.
  • Train auxiliary medical staff in specialized fields.
  • Conduct clinical, laboratory, and experimental research on oncology, with a focus on environmental factors and their impact.
  • Collaborate on joint research projects with other universities and oncology units locally and internationally.
  • Promote early cancer detection.

- Standard Infection Control Precautions in Oncology Units

Cancer patients are among the most vulnerable to infections in hospitals, requiring strict adherence to infection control measures when dealing with them.

Sources of Infection and Types of Causative Microbes:

  • Internal sources: From the patient’s own body.
  • External sources: From the environment, surfaces, devices, supplies, and healthcare providers.
  • Microbes from external sources are generally more resistant to antibiotics compared to internal microbes.

Strategies to Reduce Infection Risks in Oncology Units

1.  Hand Hygiene
Hands are the primary means of transmitting infections. Visitors and healthcare workers must adhere to hand hygiene protocols.

2.  Wearing Personal Protective Equipment (PPE)

o   Gloves must be worn when handling patients, replaced, and hands cleaned afterward.

o   A plastic apron should be worn when dealing with body fluids.

3.  Precautions During Intravenous Therapy

o   Wash hands thoroughly and wear a head cover, face mask, medical gown, gloves, and ensure the use of sterilized sheets.

o   Maintain a sterile environment to reduce infection risk.

Infection Outbreak Management in Oncology Units

1.  Addressing Infections

1.  Evaluate infection control systems and procedures.

2.  Establish mechanisms for rapid identification of infection sources in hospitals.

3.  Monitor identified cases, track developments, and prepare final reports.

4.  Assess the immune response to antibiotics in infected cases.

5.  Monitor trends in microbial resistance or susceptibility to antibiotics.

6.  Develop mechanisms to study and track resistant microbes.

7.  Identify immunocompromised patients vulnerable to hospital-acquired infections.

8.  Adhere to contamination prevention protocols.

2.  Patient Equipment and Environmental Monitoring

1.  Assign specific tools for each patient’s evaluation.

2.  Implement preventive measures, including monitoring the health of medical staff and administering vaccines.

3.  Develop programs to monitor isolation areas or areas requiring special precautions.

4.  Prohibit plants and children’s toys in the unit.

5.  Review and evaluate health and environmental monitoring policies.

6.  Assess cleaning and sterilization procedures.

7. Evaluate standards governing service quality, workforce requirements, and equipment.

8. Prepare reports and recommendations for addressing environmental issues in line with hospital infection control needs.

Care for Patients on Mechanical Ventilation

1.  Elevate the bed to a 30–45-degree angle.

2.  Avoid excessive use of anti-acid medications.

3.  Initiate physical therapy and breathing exercises promptly.

4.  Replace the oxygen humidifier every 24 hours.

Drug Preparation Area

  • The drug preparation area must be separate from patient rooms.

Ventilation

  • Windows must remain closed, and ventilation should be centralized.

Alcohol-Based Hand Rub Stations

  • Stations must be placed near the unit entrance.

Healthcare Providers

  • Providers must receive all necessary vaccinations.

Unit Hygiene

  • Clean and disinfect according to the schedule and after patient discharge.

Patient Isolation

  • Isolate suspected or confirmed cases of infection.

Visiting Policy

  • Limit visitor access to the unit.

Patient Care Equipment

  • Equipment should not be washed, cleaned, or sterilized in the unit. Instead, transfer it outside the unit for sterilization.

- General Overview of Cancer

What is a Tumor in the Body?

A tumor is a mass or group of tissues that results from the accumulation of abnormal cells due to the abnormal growth of tissues. Not all tumors are cancerous; they can be benign or malignant (cancerous). Tumors can spread from one organ to another. The size of tumors varies; they can range from a small lump to a large mass, depending on the type of tumor.

Types of Tumors:
Tumors are divided into three types:

1. Benign Tumor:
Benign tumors are non-cancerous and usually do not spread to other organs, or if they do, it is very slow. These tumors are generally not dangerous, but if they grow large and press against important parts of the body, such as nerves or blood vessels, they may cause pain or damage. Typically, once removed, benign tumors do not return.

Examples of benign tumors include:

  • Adenomas, treated surgically.
  • Lipomas, the most common type of benign tumor in adults, growing from fat cells and treated by liposuction in the area.
  • Myomas, which usually affect the uterus and stomach, treated with medication or surgery.
  • Nevi (moles), which are skin growths that can be pink, brown, or black. Any change in size, shape, or color requires medical consultation.
  • Papillomas.

2. Premalignant Tumor:
Premalignant tumors are non-cancerous but have the potential to turn into malignant tumors at any moment, and they must be monitored regularly.

Examples of premalignant tumors include:

  • Actinic Keratosis, abnormal skin growth usually affecting those with fair skin, with increased risk due to prolonged sun exposure.
  • Cervical Dysplasia, often detected by a Pap smear, caused by the Human Papillomavirus (HPV). This growth may transform into cancer in 10-30 years, leading to cervical cancer.

3. Malignant Tumor:
Malignant tumors are cancerous and often spread to other organs due to the rapid growth of cells. These tumors are generally life-threatening.

Examples of malignant cancerous tumors include:

  • Carcinoma, which can affect the stomach, prostate, pancreas, lungs, liver, colon, and breast, being the most common type of malignant tumor.
  • Sarcoma, which affects cartilage, bones, fat, and nerves.
  • Germ Cell Tumor, which typically affects the ovaries and testes, and the cells producing sperm and eggs, but can also affect the brain and abdomen.
  • Blastoma, more common in children, leading to tumors in the brain, eye, and nervous system.

The table below outlines the main distinguishing features of benign and malignant tumors.

Distinguishing Features

Malignant Tumor

Benign Tumor

1. Cell Features

Cells are undifferentiated and often poorly resemble the normal cells of the tissue they originated from.

Cells are well-differentiated and resemble the normal cells of the tissue they originated from.

2. Growth Method

Grows in the periphery, sending out processes that infiltrate and destroy surrounding tissues.

Grows by expansion and does not infiltrate surrounding tissues.

3. Growth Rate

Growth rate varies and depends on the level of differentiation. The more mutated the tumor, the faster its growth.

Growth rate is usually slow.

4. Spread

It reaches blood and lymphatic channels, spreading to other parts of the body.

Does not spread.

5. General Effects

Often causes systemic effects like anemia, weakness, and weight loss.

Usually localized, and does not cause systemic effects unless its location interferes with vital functions.

6. Tissue Destruction

Often causes widespread tissue damage due to tumor growth exceeding blood supply or obstructing blood flow to the area; may also produce substances that damage cells.

Generally does not cause tissue damage unless its location interferes with blood flow.

7. Ability to Cause Death

Usually causes death unless its growth can be controlled.

Does not usually cause death unless its location interferes with vital functions.

- Symptoms Based on the Type of Tumor

There are more than 200 different types of cancer, many of which share similar early symptoms. However, there are specific symptoms that are more indicative of particular types of cancer. Here are some symptoms linked to specific types of cancer:

Breast Cancer Symptoms:

  • Feeling a lump in the breast or underarm area.
  • Changes in the skin of the nipple or breast, such as wrinkling, peeling, or redness.
  • Discharge from the nipple.

Prostate Cancer Symptoms:

  • Painful urination or difficulty urinating.
  • Incontinence.
  • Presence of blood in urine or semen.
  • Pain during ejaculation.
  • Erectile dysfunction.

Skin Cancer Symptoms:

  • Peeling in a specific area of the skin.
  • Changes in a mole, such as color, shape, size, or irregular edges, or noticing discharge or bleeding from the mole.
  • Appearance of a flesh-colored lump.
  • Difficulty or failure of a wound to heal.

Lung Cancer Symptoms:

  • Persistent cough lasting for a long time without an infection, cold, or allergy to explain it.
  • Sometimes accompanied by a few drops of blood.
  • Shortness of breath, and frequent feelings of it unusually.
  • Voice changes or hoarseness without reason.
  • Noticeable blood in sputum.

Gastrointestinal Cancer Symptoms:

Cancers can affect various parts of the digestive system, including:

  • Esophagus Cancer: Difficulty swallowing, especially solid or non-liquid foods like bread or meat, unexplained weight loss, coughing, and hoarseness.
  • Stomach Cancer: Loss of appetite, blood in stools, feeling full quickly after eating small amounts, nausea, and occasional vomiting with blood.
  • Colon and Rectum Cancer: Blood in stools, feeling of fullness or bloating, abdominal pain and cramping, and unexplained weight loss.

Female Reproductive System Cancer Symptoms (e.g., Uterine, Cervical, and Vaginal Cancer):

  • Vaginal bleeding.
  • Abnormal vaginal discharge.
  • Pain during intercourse.
  • Difficulty urinating.
  • Changes in appetite for a prolonged period.

Male Reproductive System Cancer Symptoms (e.g., Testicular, Prostate, and Penile Cancer):

  • Lumps or swelling in the testes or penis.
  • Pain during ejaculation or urination.
  • Difficulty urinating.
  • Prostate enlargement.
  • Pain in the scrotum, groin, or lower back.
  • Presence of blood in urine or semen.

- Cancer Spread Symptoms

In some cases, cancer cells spread to different organs, such as the liver, lungs, bones, or brain. This can cause symptoms depending on the affected area:

  • Brain: Headaches, seizures, and dizziness.
  • Bones: Bone pain and fractures.
  • Liver: Abdominal swelling or jaundice.

- Risk Factors for Cancer

  • Family History: Some families face a significantly higher risk of developing cancer.
  • Genes and Chromosomes: The increased risk of developing cancer is sometimes linked to a specific gene, and at other times, it may be due to the interaction of multiple genes. Environmental factors that affect all family members may alter this genetic interaction and lead to cancer.
  • Age: Certain cancers, such as Wilms tumor, retinoblastoma, and neuroblastoma, particularly affect children. Cancer cases resulting from suppressor gene mutations can either be inherited or occur during fetal development. However, most other types of cancer are more common in adults, especially the elderly.
  • Environmental Factors: Many environmental factors increase the risk of developing cancer. Tobacco smoke contains several carcinogens that significantly raise the risk of cancer in the lungs, mouth, throat, esophagus, kidneys, and bladder. Water and air pollutants such as asbestos, industrial waste, and cigarette smoke also increase the risk of cancer. Numerous chemicals are known to cause cancer, and several other substances are suspected of contributing to the disease.
  • Geographical Location: The risk of cancer varies depending on where a person lives, and the reasons for geographic differences are often complex and not well understood. The geographic variation in cancer risk is attributed to a combination of genetic, dietary, and environmental factors.
  • Diet: The foods consumed in a person's diet can increase the risk of cancer. For example, a diet rich in unsaturated fats, as well as obesity itself, is associated with a higher risk of colon cancer, breast cancer, and possibly prostate cancer.
  • Medications and Medical Treatments: Some medications and medical treatments may increase the risk of cancer. For example, estrogen found in oral contraceptives may slightly increase the risk of breast cancer in women currently using them or those who used them within the past few years. Estrogen and progestin hormones, which may be prescribed to women going through menopause (hormone replacement therapy), may also slightly increase the risk of breast cancer.
  • Infections: Several viruses are known to cause cancer.
  • Inflammatory Disorders: Inflammatory disorders often increase the risk of developing cancer. These disorders include ulcerative colitis and Crohn’s disease, which can lead to colon cancer and bile duct cancer.

- Nursing Care for Cancer Patients

The observation of nursing staff helps in conducting an accurate assessment of the patient's condition, which in turn helps identify and address the patient's physical and psychological needs. Nursing staff are committed to assisting the patient and their family members or companions, accompanying them through all stages of the illness, and providing health education to help the patient cope with the disease and the side effects of treatment, ensuring security and trust throughout the stages of the illness. The nursing staff serve as a vital link between various departments in the cancer care unit. They work alongside the oncologist to monitor the progression of the disease and ensure the patient's health.

The clinical nurse has four essential functions: care, education, coordination, and communication.

1. Care
• Provide comprehensive care to the patient and their environment through a care plan that includes: assessment, planning, implementation, and evaluation.
• Collect and assess patient data to identify problems and potential areas for improvement.
• Ensure continuity of care through follow-up via phone, in-person visits, email, or all of these methods.
• Provide an environment where the patient and their family are the center of care.
• Create a collaborative environment with other members of the multidisciplinary team to improve patient care.

2. Education
• Assess the patient's needs and their social and cultural environment in order to provide appropriate health education for each case.
• Provide and reinforce patient education on their diagnosis, treatment, and how to manage side effects.
• Educate the patient about the role of the clinical nurse and the multidisciplinary team, focusing on healthy lifestyle patterns, patient empowerment, the importance of adhering to treatment, following medication schedules, and other protocols.

3. Coordination
• Act as a liaison between various departments involved in cancer patient care.
• Assess the patient's needs during the first nursing visit for referral to other support services (oncology psychology, nutrition specialists, etc.), always using appropriate assessment tools and updating the patient's status.
• Provide psychological support for a smooth transition from active treatment to the survivorship phase by coordinating a comprehensive care plan within a multidisciplinary team, ensuring sufficient follow-up throughout the treatment period.

4. Communication
• Build therapeutic and trust-based relationships with the patient, family, and primary caregivers through effective communication, active listening, and empathy.
• Act as a liaison between patients and caregivers to improve patient outcomes.
• Monitor the patient, enhance optimal care, and respond promptly to their needs.
• Provide psychological support to the patient and family during the toughest moments of the illness.
• Facilitate communication between members of the multidisciplinary team to prevent delays in patient care.

- Cancer

Cancer is an abnormal growth of cells (typically originating from a single abnormal cell). The cells multiply continuously due to the loss of natural control mechanisms, invade nearby tissues, and spread to distant parts of the body, stimulating the growth of new blood vessels from which cancerous cells derive nutrients. Malignant cancer cells can develop from any tissue within the body.

When cancerous cells grow and multiply, they form a mass of cancerous tissue (a tumor) that invades and destroys the surrounding normal tissues. The term "tumor" refers to abnormal growth or mass. Tumors can be cancerous or non-cancerous. Cancerous cells can spread from their primary sites to other parts of the body (metastasis).

Types of Cancer:
• Carcinoma: Malignant cells in epithelial tissues and the skin.
• Sarcoma: Malignant cells in connective tissues, muscles, and bones.
• Leukemia: Malignant cells in the blood or blood-forming organs.
• Lymphoma: Malignant cells in the lymph nodes.

Malignant cancer tissues can be divided into blood tissues and blood-producing tissues—leukemias, lymphomas, and solid tumors (solid masses of cells). Solid cancerous tumors can be classified into two types: carcinomas and sarcomas. Specific types of cancers can be further classified according to the organ where they first appeared or the type of cell they originate from, for example, squamous cell carcinoma in the skin.

Leukemia and lymphomas affect blood and blood-producing tissues and immune system cells. Leukemia arises from blood-forming cells and leads to an overproduction of normal blood cells in the bone marrow. Cancerous cells from lymphomas lead to enlarged lymph nodes, resulting in large masses in the armpit, upper thigh, abdomen, and chest.

Carcinomas are cancers affecting the cells lining the skin, lungs, digestive tract, and internal organs. Examples of carcinomas include skin cancer, breast cancer, colon cancer, stomach cancer, breast cancer, prostate cancer, and thyroid cancer. Carcinomas occur at higher rates in older individuals compared to younger ones.

Sarcomas are cancers that affect mesodermal cells, which form muscles, blood vessels, bones, and connective tissues. Examples of sarcomas include smooth muscle sarcoma (or smooth muscle cancer found in the walls of the digestive system) and osteosarcoma (bone cancer). Sarcomas occur more frequently in younger individuals compared to older ones.

- Treatment Methods and Nursing Care for Cancer Patients

Treatment Goal:

  • Alleviating symptoms related to the disease.
  • Complete eradication of malignant cancer.
  • Prolonging life and controlling cancer cell growth.

Considerations for Treatment Selection:

  • The type of disease and outcomes from each treatment method.
  • The patient’s general condition and co-existing illnesses.

Common Treatment Methods for Cancer: Various methods are commonly used in cancer treatment, including:

1. Surgery

2. Radiation therapy

3. Chemotherapy

4. Hyperthermia (Heat therapy)

5. Acupuncture

6. Hormone therapy

7. Gene therapy

8. Bone marrow and stem cell transplantation

- How to Prevent Cancer

Currently, between 30% and 50% of cancer cases can be prevented by avoiding risk factors and implementing evidence-based prevention strategies. Cancer burden can also be reduced through early detection and providing adequate treatment, care, and information to patients. It’s known that chances of recovery from many types of cancer increase if detected early and treated appropriately.

1.     Early Detection: Cancer-related deaths can be reduced when cancers are detected and treated early through methods such as early diagnosis and screening.

2.     Early Diagnosis: It’s certain that early diagnosis allows for faster response to treatment, increases survival rates, reduces disease rates, and lowers costly treatment expenses. Significant improvements can be made in the lives of cancer patients through early detection and avoiding delays in care. The components of early diagnosis include:

  • Ensuring the patient is aware of the signs and symptoms of cancer in its various forms, and seeking medical advice when noticing abnormal results.
  • Providing access to clinical assessment and diagnostic services.
  • Referring the patient in a timely manner for treatment services. Ongoing cancer control programs and initiatives should be designed to reduce delays in diagnosis, treatment, supportive care, and overcome barriers.

3.     Screening: The aim of screening is to identify individuals whose screening results suggest they may have a certain type of cancer or are in an early stage before symptoms appear. If a case is identified during screening, further tests should follow to confirm the final diagnosis, and the patient should be referred for treatment if cancer is confirmed.

Screening programs are effective for some types of cancer but not all. They are generally more complex and expensive than early diagnosis because they require special equipment and specialized health teams. Therefore, early diagnosis programs remain essential, along with age or risk-based screening. Examples of screening methods include:

  • Human Papillomavirus (HPV) testing, including RNA and DNA tests, as preferred methods for screening cervical cancer.
  • Mammography for breast cancer screening for women aged 50 to 69.

- Cancer Prevention

Most types of cancer can be prevented by following basic steps to reduce their risks. Here are eight simple tips that include actions such as maintaining a healthy weight, exercising regularly, and avoiding tobacco use. There are also additional steps that can reduce the risk of specific types of cancer.

·  Follow a Healthy Diet: Increase the intake of fresh fruits and vegetables, along with plant-based foods like whole grains, in your daily diet.

·  Maintain an Ideal Weight: Maintain an ideal weight by choosing foods with lower calories, limiting sugars, and reducing animal fats.

·  Limit Alcohol Consumption: Excessive alcohol consumption increases the risk of breast cancer, colon cancer, and lung cancer.

·  Quit Smoking: Different types of tobacco can cause cancers such as oral, throat, lung, and pancreatic cancer. Deciding to quit smoking helps protect against cancer risk.

·  Vaccination:

1. Human Papillomavirus (HPV) vaccine: Helps protect women from cervical cancer and other types of cancer.

  1. Hepatitis B vaccine: Protects against liver cancer.

·  Limit Processed Meat Intake: The International Agency for Research on Cancer (IARC), a part of the World Health Organization, has confirmed that reliance on processed meats increases the risk of certain types of cancer.

·  Avoid Sun Exposure: Long-term sun exposure increases the risk of skin cancer, which is the most common type. To protect yourself:

▶️  Wear protective sunglasses.

▶️  Cover exposed areas of your skin.

▶️  Use sunscreen every two hours.

▶️  Avoid tanning beds as they are harmful, just like natural sunlight.

·  Avoid Virus Transmission: It’s important to prevent the transmission of certain viruses that increase the risk of liver cancer, such as the Human Immunodeficiency Virus (HIV), Hepatitis B, and Hepatitis C.

- References

 National Institute on Aging. (n.d.). A good night's sleep. Retrieved from https://www.nia.nih.gov/health/good-nights-sleep

  American Society of Clinical Oncology. (2015). A conceptual framework to assess the value of cancer treatment options. Journal of Clinical Oncology, 33(23), 2677-2684. https://doi.org/10.1200/JCO.2015.61.6706

  Balachandran, D. D., et al. (2021). Evaluation and management of sleep and circadian rhythm disturbance in cancer. Current Treatment Options in Oncology. https://doi.org/10.1007/s11864-021-00872-x

  Oxford University Press. (n.d.). Breast cancer. In Oxford: Oxford University Press (Chapter 13). ISBN 978-0-19-955869-8.

  Cancer Institute NSW. (2020). Last reviewed September 2020.

  National Cancer Institute. (n.d.). Facing forward: Life after cancer treatment. Retrieved from https://www.cancer.gov/publications/patient-education/facing-forward

  Fidalgo, J. A., Pérez, L., García-Fabregat, A., et al. (2012). Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Annals of Oncology, 23(Supplement 7), vii167–vii173. https://annonc.oxfordjournals.org/content/23/suppl_7/vii167.full.pdf

  Global Burden of Disease Study. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053), 1545–1602.

  National Cancer Institute. (n.d.). Hormonal therapy to treat cancer. Retrieved from https://doi.org/10.1200/JCO.2015.61.6706

  Siteman Cancer Center. (n.d.). Retrieved from https://siteman.wustl.edu/ar/

  Cancer.net. (n.d.). Long-term side effects of cancer treatment. Retrieved from https://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment

  Mader, I., Furst-Weger, P. R., Mader, R. M., et al. (2013). Extravasation of cytotoxic agents: Compendium for prevention and management. Springer-Verlag.

  Prince Sultan University, College of Applied Sciences. (n.d.). Management of patients with oncologic disorders.

  National Cancer Institute. (n.d.). Psychological stress and cancer. Retrieved from https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet

  JNCI: Journal of the National Cancer Institute. (2016). Quality-of-life assessment in cancer treatment protocols: Research issues in protocol development. Journal of the National Cancer Institute, 84(8), 575-579. https://doi.org/10.1093/jnci/84.8.575

  Rock, C. L., et al. (2020). American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians. https://doi.org/10.3322/caac.21591

  Rock, C. L., et al. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: A Cancer Journal for Clinicians. https://doi.org/10.3322/caac.21719

  National Cancer Institute. (n.d.). Sleep disorders (PDQ)—Patient version. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq#section/all

  National Comprehensive Cancer Network. (n.d.). Survivorship. Retrieved from https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1466

  Yeo, C. J., McFadden, D. W., Pemberton, J. H., Peters, J. H., Matthews, J. B. (2012). Shackelford's Surgery of the Alimentary Tract. Elsevier Health Sciences. ISBN: 978-1455738076.

  Mansoura University Cancer Center. (n.d.).

  Ministry of Health and Population, Specialized Medical Councils, National Cancer Network. (n.d.).