HELP! Focus of care for metastatic breast CA?

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Specializes in Med Surg.

Hey--- I'm in a dilemma. I am writing a paper about breast cancer which metastasized to the liver and bones. All I am finding online as far as the focus of nursing care for this patient is to give comfort care. Once the cancer metastasizes to the bones all of a sudden they stop treating it? Sorry, I am just stuck, cause I want there to be some happy stuff, not just writing that the patient is dying and all I can do is provider for her comfort..... Any ideas or websites to check would be greatly appreciated!!

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I know that for metastatic CA you give comfort empathic care.I dont know of any website that has any other thing to add to that.Goodluck in your writings.

Azor

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Specializes in rehab, dementia.

Sarani...

this may be a long shot, but perhaps you can go the the american cancer society website. perhaps google metastatic breast cancer support group...maybe for families. I had the opportunity to do a term paper on death and dying. After searching...I emailed a person who organized a a support group and I emailed her questions and I was able to use the interview in my paper.

Perhaps you can check out Calvary Hospital in the Bronx, NY...they are a hospice facility. Also, the visiting nurse service in NY...they have a hospice program. They may be able to assist. Hope some of these ideas help.

Good luck....take care!

Ang

Hey--- I'm in a dilemma. I am writing a paper about breast cancer which metastasized to the liver and bones. All I am finding online as far as the focus of nursing care for this patient is to give comfort care. Once the cancer metastasizes to the bones all of a sudden they stop treating it? Sorry, I am just stuck, cause I want there to be some happy stuff, not just writing that the patient is dying and all I can do is provider for her comfort..... Any ideas or websites to check would be greatly appreciated!!
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from professional guide to diseases, 8th edition:

treatment for liver cancer: because liver cancer is commonly in an advanced stage at diagnosis, few hepatic tumors are resectable. a resectable must be a single tumor in one lobem without cirrhosis, jaundice, or ascites. radiation therapy is usually pallative. because of the livers low tolerance for radiation, external beam radiation hasn't increased survival. however, radiolabeled antibodies have been used to selectively target cancer tissue; when used concurrently with chemotherapy, patients can convert from nonresectable to resectable. another method of treatment is chemotherapy with i.v. fluorouracil, mitomycin, or doxorubicin, or with a regional infusion of florouracil or floxuridine (catheters are placed directly into the hepatic artery or left brachial artery for continuous infusion for 7-21 days, or permanent implantable pumps are used on an outpatient basis for long-term infusion).

treatment for malignant bone tumors: excision of the tumor with a 3" (7.6cm) margin is the treatment of choice. it may be combined with preoperative chemotherapy. in some patients, radical surgery (such as hemipelvectomy or amputation) is necessary; however, surgical resection of the tumor has saved limbs from amputation. chemotherapy may be used intraarterially into the long bones of the legs.

nursing interventions:

~watch for signs of infection. be alert for even a low-grade fever when the granulocyte fall below 500; take temp. often.

~increase fluid intake before and throughout chemo/

~check skin for petechiae, ecchymosis, chemical cellulitis, and secondary infection during chemo treatment.

~minimize tissue irritation and damage by checking needle placement before and during chemo infusion if using a peripheral vein.

~administer analgesics.

~teach patient to adjust body weight so e can get in and out of bed and wheelchair.

~encourage some exercise. administer laxatives, if necessary, to maintain proper elimination.

~control edema and ascites. most patients need a diet that restricts na and protein (for liver ca). weight patient daily. measure abdominal girth daily. elevate patients legs whenever possible to promote venous return.

~watch for encephalopathy. many patients develop end-stage signs or symptoms of ammonia intoxicaion, including confusion, restlessness, irritability, agitation, delirium, lethary, and finally, coma. monitor serum ammonia levels and neurologic status. be prepared to control ammonia accumulation with sorbitol (to induce osmotic diarrhea), neomycin (to reduce bacterial flora in gi tract), lactulose (to control bacterial elaboration of ammonia), and sodium polystyrene sulfonate (to lower k+ level).

i hope this is what you were looking for. good luck on your paper!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

sarani. . .treatment, where nursing in concerned, is almost always based upon the symptoms the patient is having. treatment of the disease process is in the hands of the doctors, not the nurses. if you are looking for treatment of the medical disease look for breast cancer on the website of the national cancer institute (http://www.cancer.gov/). click on the link for breast cancer on this website and you will find all about how breast cancer metastasizes and the medical treatments that are available for it including the current clinical trials for the aggressive treatment of it. there will be explanations for the patient and for professionals for you to read.

as far as treatment for the various types of manifestations of the metastasis you need to look at the specific symptoms the patient is having. this is determined by the assessment data that is collected during the initial and ongoing assessment process. nursing interventions will be found for these symptoms and problems in your nursing textbooks and care plan books. you can also look for end of life care for some of the comfort care measures when the patient's cancer has gone beyond the point of aggressive medical treatment.

i can understand that this might be difficult to fathom. however, part of learning about cancer is learning about all the care options that are available and about the progression of the disease when treatment fails. this, unfortunately, is a reality that does occur. don't shut your feelings out about this. you're allowed to explore them. and, you will likely revisit them every time you have a patient who faces these diagnoses. your compassionate nature will be tested as well as your ability to nurture and nurse these patients. not all patients will have a happy ending. this is a cold, hard fact of our profession. this is why you must have a well-grounded personal support system to help you cope with the very personal experiences you will experience in your practice. some of them will rip at your heart. but, while your own heart is in pain, keep in mind, that it is the patient's heart we must have our first concern for. it is up to us to be aware of the choices available to them from newer aggressive surgeries, radiation therapy and chemotherapeutic agents as they become available as well as end of life care.

have a productive search for information and become a walking encyclopedia on breast cancer and treatment of its mets as a result of this assignment. my mother died of breast cancer that mets'd to her lung last year. she did every aggressive treatment that was offered to her, but the cancer still won. carry hope, but be a realist. none of us lives forever and we each face our own mortality at some point. the great privilege of being a nurse is that we get to assist patients as some of them face this reality. it is an awesome responsibility. not everyone is capable of doing it.

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