Health Education for Cancer Patients and Their Families

- Prepared by

Oncology guide

- Introduction

Diagnosing cancer is a difficult experience, not only for the patient but also for their family and loved ones. When people first hear that they have cancer, they often feel overwhelmed and don’t know what to do. Even after some time, it can still be hard to handle all the information and requirements related to the cancer diagnosis and treatment plan. Support must be provided throughout the diagnostic and treatment journey and beyond by answering any questions the patient may have. This may include information on the type and stage of cancer, introducing available treatment options, informing about essential financial resources that may be needed, or helping find transportation and accommodation to ensure access to treatment.
Educational, supportive, and awareness activities and services play a pivotal role in patient care, especially for those with chronic diseases and cancer. Through these activities, professionals from all health sectors exchange knowledge and collaborate for the benefit of the patient

- Educating Cancer Patients

The educational needs of cancer patients and their families must be addressed, including prevention, risks, treatment, survival, and end-of-life care, as health education represents the link between research and efforts in patient care. Nursing staff play a guiding role, assisting both patients and their families. Their role includes assessing needs and fulfilling them, taking into account future or ongoing support. There is a short-term plan for future communication with patients in a way that suits them, whether in person, by phone, or via email.

Cancer patients, whether newly diagnosed or living with a chronic illness, often have many questions such as:

• What is cancer?
• What specific type of cancer have they been diagnosed with?
• What are its causes?
• What are the possible treatments?
• How to cope with cancer?
• How to survive the illness?

- Overview of Cancer

Cancer is defined as an abnormal growth of cells. Cancerous cells are characterized by their abnormal shape and functional disruption, as well as their rapid growth compared to normal cells in the body. These cells can also spread to other parts of the body. In other words, cancer occurs when the body loses control over cell growth. It is essentially uncontrolled growth of abnormal cells in the body, where old cells form new abnormal ones. This contradicts the normal process of cell growth regulation, which calls for the death of old cells. As a result, the excess abnormal cells accumulate, forming a mass of tissue that the body cannot control, called a tumor. It is worth noting that cancer is not always associated with the formation of a tumor, as cancer can develop without any tumor formation, as seen in blood cancers.

Tumors are classified into malignant (cancerous) and benign tumors. Malignant tumors are characterized by their rapid growth, ability to spread to different parts of the body, and invade surrounding tissues, destroying them. On the other hand, benign tumors grow in a specific area of the body and have a lower growth rate.

Carcinoma in situ: Although the term "carcinoma in situ" sounds like it refers to a type of cancer, it is not actually a cancer type, despite its severe nature. These cells do not have the ability to spread to adjacent tissues but can develop into cancerous cells in some cases. Therefore, most cases of carcinoma in situ are treated to prevent their development into full cancer.

- Causes of Cancer

A primary cause for cancer cannot be pinpointed, but several factors may contribute to its occurrence, including environmental, genetic factors, and an individual's unique traits. The mechanism through which a normal cell turns into a cancerous cell is believed to involve several genetic mutations in the cell’s DNA, particularly mutations affecting the part responsible for directing cell growth and division. Any error in the instructions that normally stop the cell from performing its regular functions may allow it to transform into a cancerous cell. There are many reasons for these mutations, which can be divided into hereditary mutations, passed from the parents, and acquired mutations that occur after birth and are responsible for most cases of cancer.

These mutations can occur due to various causes such as exposure to certain chemicals, radiation, viruses, smoking, unhealthy lifestyle choices, obesity, and certain hormonal disorders or chronic inflammation. It is important to note that the body’s cells have defensive mechanisms to protect against these mutations and disruptions in their genetic material. However, in rare cases, cells may fail to detect these disruptions, leading to their transformation into cancerous cells. It is also noteworthy that a cell typically does not become cancerous unless it has undergone several genetic mutations. Scientists have not yet determined the exact number of genetic mutations that lead to cancer, and it is believed that the number of mutations causing cancer depends on the type of cancer.

Although some inherited mutations may increase the risk of cancer, they do not necessarily mean the person will develop cancer. In such cases, the individual may need fewer acquired mutations for a cell to turn cancerous.

- Risk Factors for Cancer

There are several risk factors that may increase the likelihood of developing cancer. Risk factors are defined as factors that increase the chance of developing a disease, though they do not directly cause it but may decrease the body’s ability to resist the disease. The following are cancer risk factors:

1. Lifestyle Habits: Unhealthy lifestyle choices can increase the risk of certain types of cancer, such as consuming fatty foods, smoking, or working in an environment that exposes you to toxic chemicals. However, these risk factors do not play a significant role in childhood cancers due to limited exposure to these unhealthy patterns for extended periods, but they have a greater impact on adults.
2. Family Health History: This factor can play an important role in childhood cancer. As mentioned earlier, inheriting certain genetic mutations increases the risk of some cancers, and family conditions may contribute to multiple people in the same family being affected by cancer, such as being exposed to the same amount of certain chemicals due to living in the same home or environment.
3. Genetic Diseases: Certain genetic disorders affecting the immune system and bone marrow, such as Wiskott-Aldrich syndrome, can impair the immune system’s ability to fight cancer, causing stem cells in the bone marrow to divide into mutated or cancerous cells in some cases. This stem cell disorder may be caused by exposure to certain toxins, viruses, or genetic mutations.
4. Certain Viruses: Some viruses can increase the risk of developing cancer, particularly in childhood, by causing cellular disruptions that occur repeatedly as cells divide. Examples of cancers that may develop from viral infections include Hodgkin lymphoma and Non-Hodgkin lymphoma. Viruses that may increase cancer risk include Epstein-Barr virus and the Human Immunodeficiency Virus (HIV), which causes AIDS.
5. Environmental Factors: The risk of cancer increases with repeated exposure to certain types of fertilizers and pesticides. Some statistics have shown higher rates of certain cancers in specific areas, even without familial links, possibly due to shared environmental factors among these cases.
6. Radiation and Chemotherapy Treatment: Previous exposure to high doses of radiation or chemotherapy to treat other types of tumors may increase the risk of developing secondary cancers later in life, as these treatments can cause immune system disturbances or affect cells in the body.

- How Cancer Spreads

For cancer cells to spread to nearby tissues or other parts of the body, they must be able to bypass the body’s internal barriers. In the early stages of cancer, benign tumors form, and the cancer cells do not have the ability to penetrate the surrounding tissue. As the disease progresses and transforms into a malignant tumor, cancer cells may produce enzymes called proteases that help them break through the extracellular matrix, tissue boundaries, and connections between surrounding healthy cells, facilitating the spread of cancer cells to nearby tissues. In later stages, some cancer cells may even break through the body’s barriers, such as blood vessels and lymphatic vessels, leading to the spread of cancer to other areas and organs. This is known as metastasis.

- Types of Cancer

Cancer can be divided into two main categories: blood cancers, including leukemia and lymphoma (cancers of the lymphatic glands), and solid cancers, which affect the tissues of other parts of the body. These solid cancers are further divided into carcinoma and sarcoma.

• Lymphoma: Cancer cells in lymphoma originate in the lymph nodes, causing large masses of tumors in areas where the lymph nodes are found, such as the chest, armpits, abdomen, and groin.
• Leukemia: Leukemia begins in cells responsible for blood production in the bone marrow, affecting its ability to produce normal blood cells.

Carcinoma: This type of cancer is more common in older adults compared to the young, originating in cells lining internal organs, the lungs, digestive system, and skin. Examples include thyroid, prostate, colon, breast, skin, and lung cancer.

Sarcoma: Unlike carcinoma, sarcomas are more common in younger people than in the elderly. This type of cancer originates from mesodermal cells, which form connective tissue, muscles, bones, and blood vessels. Examples include osteosarcoma (bone cancer) and smooth muscle sarcoma, which develops in the smooth muscles of the stomach.

- Symptoms of Cancer

Symptoms of cancer usually appear when the cancer starts affecting one of the body’s functions. Therefore, cancer symptoms can vary depending on its location. It’s important to note that the symptoms associated with cancer do not necessarily mean a cancer diagnosis, as they could also be caused by other health issues. Here are some of the symptoms that may accompany cancer:

1. The appearance of an unusual lump in the armpit, neck, or any other part of the body.
2. Noticeable changes in the breast, such as changes in shape, color, pain, discharge from the nipple, alterations in its natural shape, or increased thickness or wrinkling in a specific area of the breast.
3. Unexplained weight loss.
4. Vaginal discharge or abnormal vaginal bleeding.
5. The appearance of sores that do not heal. Chronic bloating.
6. Feeling of incomplete bowel evacuation after defecation. Chronic, unexplained diarrhea or constipation. Unexplained rectal or abdominal pain. Disturbances in bowel function lasting more than two weeks, with blood in urine or stool.
7. Hoarseness, chronic cough, or coughing up blood.
8. The appearance of new skin moles or spots, or changes in the size, shape, or color of old moles, or noticing them bleeding.

- Cancer Diagnosis

Most cases of cancer are diagnosed after symptoms appear or a tumor is detected. Early detection plays a significant role in improving the chances of recovery. Some types of cancer can be detected early through routine self-examination, such as breast, oral, testicular, skin, and anal cancers. In some cases, cancer may be diagnosed incidentally when diagnosing or treating another health issue, but this is rare.

There are several diagnostic tests to help detect cancer, in addition to tests conducted after diagnosis to determine the stage of cancer, its spread, the appropriate treatment, and the expected recovery rate. Here are some common diagnostic tests for cancer:

1. Clinical Examination: The doctor performs a thorough clinical examination to check for skin changes, lumps, tumors, or abnormal swelling in the body.
2. Laboratory Tests: Blood and urine tests help detect disorders caused by cancer.
3. Imaging Tests: There are several imaging tests used to detect cancer, which help get accurate pictures of the internal body parts, such as X-rays, ultrasound, CT scans, MRI, and PET (Positron Emission Tomography).
4. Biopsy: A biopsy is one of the most accurate methods for diagnosing cancer. The doctor takes a sample from the tissue or tumor and analyzes it in the laboratory. The method of obtaining the sample depends on the type and location of the cancer.

- Cancer Treatment

The goal of cancer treatment is to remove or destroy cancer cells through medication or other treatment methods. The choice of treatment depends on several factors such as the tumor's location, the patient’s ability to tolerate treatment, the cancer stage, and how far it has spread in the body. Here are some common treatment methods for cancer:

1. Surgery: Surgery is one of the main and effective treatments for many types of cancer. It is one of the oldest treatment methods still in use. The decision to use surgery depends on factors such as the patient’s overall health, the type of cancer, the tumor’s size, its spread to other parts of the body, and its location. In some cases, surgery alone may be sufficient to eliminate cancer, while in others, it may be combined with other treatments. Early detection contributes to the success of surgery as cancer is often contained in a specific body area in its early stages.
2. Chemotherapy: Chemotherapy refers to the use of toxic drugs (Cytotoxics) to destroy cancer cells or limit their growth and spread. It is a systemic treatment because the drugs travel through the bloodstream and target rapidly dividing and growing cells throughout the body. In some cases, chemotherapy is delivered directly to the tumor, making it a localized treatment. The method and duration of chemotherapy vary depending on the patient’s condition and the type of drug used.
3. Radiation Therapy: Radiation therapy uses high-energy radiation to target and destroy the genetic material of cancer cells, inhibiting their ability to divide and grow. It is one of the most effective treatments for cancer after surgery, depending on the patient's condition. It may be used in the early or advanced stages of cancer, particularly when the tumor has spread to other body parts.
4. Targeted Therapy: Targeted therapy involves drugs that target specific areas in cancer cells or factors contributing to their growth. These may include targeting proteins or genes within the cancer cells or cells that promote tumor growth, such as blood vessel cells supplying the tumor.
5. Immunotherapy: Immunotherapy aims to enhance the body’s immune system to destroy cancer cells, prevent their formation, or control them. It works by stimulating the immune system to recognize cancer cells or by strengthening the immune system with elements that increase its defensive capability.
6. Stem Cell Transplants: Stem cell transplantation involves transplanting umbilical cord blood or bone marrow from the patient to help combat cancer. This type of treatment is typically used for cancers affecting the blood or immune system, such as lymphoma, leukemia, and multiple myeloma. It may include removing the affected cells through chemotherapy or radiation, treating them in the lab, and then reintroducing them into the body.
7. Hormonal Therapy: Hormonal therapy involves removing or inhibiting certain hormones to slow or limit the growth of cancerous tumors. It may be used alone or in combination with other treatments, and in some cases, it may also help prevent cancer from recurring or shrink a tumor before other treatments are used.

- Tips for Cancer Patients

Cancer affects several aspects of a patient's daily life, depending on the type of treatment they will receive and the stage of the disease. More specifically, the diagnosis and treatment of cancer are associated with numerous physical and psychological changes. Physically, a person with cancer may suffer from hair loss, pain, weight changes, bloating, fatigue, eating disorders, loss of control over urination or bowel movements, scars, or the removal of an organ. These changes also affect the psychological aspect of the person due to constant reminders of the illness. Psychologically, the person may experience a wide range of emotions and changes, including social isolation, anxiety, depression, and low self-esteem.

The ways to cope with these changes differ from person to person and depend on several factors such as past experiences, the individual’s state and personality. While these coping mechanisms may have been effective in the past for reducing psychological stress, they might not be sufficient in the case of cancer. Therefore, it is crucial for the patient to seek help from others, specialists, and individuals with prior experience of the disease, to receive advice on the appropriate coping methods. The best results are achieved when multiple strategies are combined. Below are some tips that can be offered to individuals diagnosed with cancer:

• Provide information about the disease: Gaining knowledge about the disease, diagnosis, and treatment methods helps the patient understand what to expect in the future, which can, in turn, help them feel in control and secure.
• Organize knowledge about the disease: After the diagnosis, the patient begins to receive an overwhelming amount of information about their health condition and the nature of the disease, either from healthcare providers or family and friends, which may lead to confusion and disorientation. Therefore, it is advised to provide only necessary information at this stage to help the patient deal with and gradually accept this vast amount of information.
• Seek information from trusted sources only: It is important to get cancer-related information only from specialists or reliable sources to avoid inaccurate and random information.
• Don’t hesitate to ask questions: If there are any questions that the patient cannot find answers to, they should not hesitate to ask the specialized medical team. It helps to organize questions by importance on paper to ask the medical team at the right time.
• Share with others: The patient can share the new information they acquire about the disease with close people to help them understand it better and make informed decisions about what to do during this phase of the illness.
• Document important information: It can be helpful to use a notebook or a mobile app to record important information such as side effects, unknown questions, and doctor’s appointments. This information will be useful for future treatments, follow-ups, and when consulting other doctors.
• Maintain physical activity: Exercise helps release endorphins, which improve mood. Simple exercises such as walking are sufficient, and if the patient prefers not to go outside or to the gym due to visible physical changes from cancer treatment, they can exercise at home.
• Practice relaxation exercises: Relaxation techniques such as massage, deep breathing, and guided imagery are recommended.
• Consult the doctor about how to alleviate side effects: The patient should ask the doctor how to ease side effects such as skin irritation, pain, and the use of prosthetics during treatment.
• Follow a healthy lifestyle: The patient should ensure they get enough rest and follow a healthy, balanced diet to maintain energy levels and reduce fatigue from cancer treatment.
• Seek help from family and friends: The patient should be encouraged to ask for help from family and friends with household tasks or other duties, and not refuse help. Instead, they should thank those offering help to encourage further assistance, which can alleviate physical and psychological pressure on both the patient and their family.
• Rearrange goals and priorities: During this phase, the patient is advised to focus on the most important life goals, engage in activities that provide a sense of accomplishment, and reduce stress and pressure on those close to them.

Additionally, there are general tips that the patient should follow:

1. Achieve an ideal weight and avoid weight gain during treatment. Overweight patients should seek professional help to lose weight safely after treatment and recovery.
2. Follow a healthy diet: A diet rich in fruits, vegetables, whole grains, poultry, and fish is recommended. Consumption of red meat, processed meats, sweets, full-fat dairy products, and fried foods should be minimized. There is no evidence that taking vitamins, herbal remedies, or supplements can help cancer patients live longer and some may even cause harm, so it is important to consult the doctor before using any supplements.
3. Exercise regularly: Physical activity can help maintain good health during treatment and after recovery. It is recommended to exercise for 10-15 minutes, with moderate to intense effort, to raise heart rate and breathing rate. Enjoyable activities such as brisk walking, swimming, and cycling can also be done.
4. Get enough sleep: Cancer patients often have difficulty sleeping. To improve sleep quality, it is advisable to avoid napping during the day, stay away from caffeine or coffee, and go to bed and wake up at the same time daily. Techniques such as yoga, meditation, and massage therapy can promote relaxation.
5. Take necessary treatment: Several treatment options are available. After undergoing treatment, the patient may need time to return to normal life, especially as many treatments cause severe fatigue requiring rest.
6. Follow-up with the doctor: The patient should have regular check-ups after treatment, typically every 3-6 months for 1-2 years, which may include blood tests or X-rays to monitor the cancer's response to treatment. If the patient has had breast cancer, they should undergo mammography annually for 5 years after treatment.
7. Advice for coping with psychological symptoms: Many cancer patients experience anxiety due to pain or other issues. New medications and therapies are effective in managing pain and discomfort. Psychological support is also crucial for patients, such as talking to family and friends or seeking professional counseling to help solve emotional struggles.
8. Maximize energy: Patients may feel energetic on some days and exhausted on others. They should engage in enjoyable activities on energetic days and rest on others. Activities like listening to music, reading, or spending time with friends can help alleviate fatigue.

- Cancer Patient Care

Family members and friends play an essential role in providing care for a person with cancer, whether the cancer is in its early or advanced stages. This involves offering practical, physical, and emotional support to the patient. Nurses or family members perform several daily tasks depending on the patient's needs, including:

• Encouraging and supporting the patient.
• Communicating with the healthcare team.
• Administering prescribed medications.
• Helping the patient manage side effects and symptoms.
• Coordinating medical appointments.
• Accompanying the patient to doctor visits.
• Assisting with meal consumption.
• Aiding with household chores.

Women who have undergone cancer treatment (e.g., breast cancer) may need cosmetic or reconstructive surgeries, such as breast reconstruction or implants. Breast reconstruction aims to restore the breast's shape after surgical removal, while implants involve reshaping the breast using silicone or saline-filled prosthetics. Reconstructive surgeries may not always achieve a perfectly natural appearance.

Patients may experience fatigue and pain for weeks following breast reconstruction surgery. Doctors prescribe pain-relieving medications, and recovery may take six weeks or more. Full recovery may take up to one or two years. During this time, certain activities, such as lifting heavy objects or strenuous physical exercise, should be avoided. Regular follow-up visits with the cosmetic surgeon are essential to monitor the new breast after surgery.

Many cancer patients fully recover and live for many years. For cases where cancer is not entirely curable, survival rates have significantly improved over time due to early detection and advancements in treatment methods. It's important to note that complete recovery is often achievable, particularly with early cancer detection.

- Cancer Prevention Methods

Preventing cancer reduces the chances of developing the disease and minimizes the burden associated with increasing cancer cases and mortality rates. Prevention can be achieved by understanding the risk factors related to genetics, lifestyle, or environmental factors and knowing how to manage them. Here are some key guidelines for reducing cancer risk:

1. Healthy Eating: Following a healthy diet plays a crucial role in preventing various diseases, including cancer. The types of foods and drinks consumed, or avoided, have a significant impact on health. To reduce cancer risk, include a variety of antioxidant-rich foods like vegetables, fruits, nuts, beans, whole grains, and healthy fats. It's essential to minimize the intake of processed foods, fried foods, sweets, refined carbohydrates, and unhealthy fats.
• High-fiber foods like fruits, vegetables, and whole grains promote digestive health and help eliminate carcinogens before they can cause cancer, particularly cancers of the digestive system (e.g., colon, rectum, stomach, mouth, and pharynx).
• Healthy fats, such as those found in nuts, fish, and olive oil, along with Omega-3 fatty acids in salmon, tuna, and flaxseeds, help maintain brain and heart health and reduce inflammation.
• Avoid trans fats and partially hydrogenated oils found in processed and fried foods (e.g., fried potatoes, fried chicken, biscuits, cakes, pies, and pizza), and limit saturated fats from red meats and dairy products. Saturated fat intake should not exceed 10% of daily calorie intake.
2. Limit Sugary, Salty, and Fatty Foods: Reducing intake of foods high in sugar, salt, and added fats helps prevent weight gain and obesity, which increase the risk of cancer. Examples include candy, chocolate, frozen desserts, and chips. Salt, in particular, can increase the likelihood of stomach cancer. Also, reduce sugary drinks like sodas, energy drinks, sweetened iced tea, fruit juices, smoothies, and flavored water, opting for low-sugar, low-calorie alternatives such as water, milk, and unsweetened tea or coffee.
3. Avoid Alcohol: Alcohol consumption is linked to various cancers, including breast, colon, rectal, liver, mouth, pharynx, and esophagus.
4. Get Nutrients from Food: Focus on obtaining vitamins and minerals from food rather than supplements, unless recommended by a doctor to address specific nutritional deficiencies. While there is no definitive evidence that specific vitamins or supplements prevent cancer, a balanced, healthy diet provides the necessary nutrients.
5. Limit Red Meat and Avoid Processed Meat: Reducing red meat consumption and avoiding processed meats (e.g., bacon, hot dogs, salami, and pepperoni) can decrease the risk of cancer, particularly stomach and colon cancers. Processed meats, which include smoked or salted poultry and fish, should be consumed in moderation.
6. Adopt a Balanced Approach to Diet: Preventive measures do not mean total abstinence but rather enjoying food in moderation while maintaining a healthy weight and lifestyle.

Physical activity, in addition to its benefit in weight management, reduces the risk of various types of cancer such as breast cancer, prostate cancer, lung cancer, colon cancer, and kidney cancer. Engaging in physical activity for 30 minutes or more daily is considered the best way to prevent the risk of cancer.

Preventing sun exposure helps in preventing skin cancer by following these tips: Avoid midday sun (between 10 AM and 4 PM), when the rays are strongest. Stay in shaded areas as much as possible when going outside, wear sunglasses and a wide-brimmed hat, cover exposed skin with clothing, and choose tightly woven clothes that are loose and brightly colored or dark. These materials reflect UV rays more effectively than white cotton or thin fabrics. Use sunscreen with at least SPF 30, apply it regularly even on cloudy days, and ensure it is applied generously and evenly on all areas of skin. Reapply every two hours, and more frequently if swimming or sweating. Avoid tanning or using sun lamps, as they have similar effects to sunlight in increasing the risk of skin cancer.

Vaccination against viral infections is an integral part of cancer prevention. Hepatitis B increases the risk of liver cancer, so vaccination against hepatitis B is recommended, especially for those at high risk. The HPV vaccine is also recommended for girls and boys aged 11-12, as the HPV virus, which is transmitted through sexual contact, is a risk factor for cervical cancer and other genital cancers, as well as squamous cell carcinoma of the head and neck.

Quitting smoking and tobacco products is critical as they are risk factors that increase the likelihood of cancers such as oral, throat, laryngeal, lung, bladder, cervical, kidney, and pancreatic cancers. Secondhand smoke exposure and inhalation of smoke-polluted air increase the risk of lung cancer by 20-30%, as the chemical carcinogen concentrations in secondhand smoke in homes or workplaces are higher than in the smoke inhaled by active smokers.

Regular check-ups and screenings contribute to the early detection of different types of cancers such as skin, colon, cervical, and breast cancers, making treatment more successful. By consulting a doctor, one can determine the appropriate tests for early cancer detection based on risk factors. Here are some important tests that can be conducted for early cancer detection or prevention:

• Mammogram: Women aged 40 and above should undergo this screening annually and continue doing so as long as they are in good health, or until they turn 70, unless other risk factors require more frequent tests.
• Colorectal Cancer Screening: Both men and women at risk for colorectal cancer aged 50 or older should undergo one of the following tests: flexible sigmoidoscopy every five years, colonoscopy every ten years, double-contrast barium enema every five years, CT colonography or virtual colonoscopy every five years, stool tests for hidden blood annually, or stool immunochemical tests annually, or DNA testing in stool once every one to three years.
• Pap Smear: All women aged 21 and older should have this test, repeating every three years for women aged 21-29. After age 30, it is preferred to have a co-test with a Pap smear and HPV test every five years until age 65, or it can be limited to a Pap smear every three years for this age group.
• Lung Cancer Screening: It is recommended to undergo low-dose CT scans for smokers aged 55-80 who have smoked for 30 years or more.

Cancer prevention occurs in three stages: Primary prevention, which involves protecting healthy individuals from cancer. Secondary prevention, which focuses on protecting a potentially cancerous area of the body from developing cancer. The third stage, tertiary prevention, focuses on preventing the development of other types of cancer in individuals already diagnosed with one type.

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