5. Control of Odors

Scrupulous cleanliness helps to control odors since most of them are the result of infection not the cancer itself. The accumulation of exudate from any lesion or body cavity results in odor from saprophytic and parastic organisms. Irrigations, douches, baths, and frequent changes of dressing, as well as the application of odor-controlling substances are helpful. Deodorizing substances are available for use on dressings. Spray deodorants are sometimes useful in masking the odor in patients' rooms. Adequate ventilation of the room and frequent changes of clothing are important.

6. Metastases to the Bones

Patients who have either metastatic disease to the bones, osteoporosis, or primary bone disease should be carefully supported when they are moved about. Careless handling may result in fractures of the arms, legs, or back as well as increased discomfort. A firm mattress is essential for those with skeletal metastases. Attention should be paid to the patient's posture in bed. The body should be in straight alinement, and foot support may be achieved with a box or a folded pillow. Frequent changes of position are essential to promote circulation and prevent bed sores.

7. Hypercalcemia

Excessive blood levels of calcium may occur with malignant disease, especially breast cancer. Symptoms include nausea, vomiting, anorexia, and constipation. With progression, drowsiness, lethargy, stupor, and visual disturbances may be noted. Water balance in the patient may be disturbed.

Nursing measures include those to control vomiting, after which the fluid intake of the patient should be increased.

8. Nausea and Vomiting

Nausea and vomiting interfere with nutrition and, if prolonged, can cause serious electrolyte imbalance. Sometimes nausea can be controlled by frequent small feedings of foods high in carbohydrate and low in fat. Solid foods are sometimes tolerated better than liquids. While some of the newer drugs are helpful in controlling nausea and vomiting these are not always available. It is sometimes possible to relieve distress by giving the patients sips of gingerale, cola, or very warm or cold carbonated water. Changing the patient's position may also help. Occasionally if no other measure affords relief gastric lavage is ordered.

9. Nutrition and Hydration

Nutrition becomes critical in the far-advanced cancer patient. Vitamin deficiencies and anemia are seen frequently, as well as weight loss and tissue wastage. Loss of appetite, nausea, vomiting, and dehydration are common. Great ingenuity is required to meet these problems. Small, attractive servings of familiar foods may tempt the patient and aid in the alleviation of psychological depression. Frequent feeding may be necessary. Of course, the nutritive content of the food should be as high as possible-in many cases, reinforced with nonfat dry milk or other protein supplement. The fluid intake should be watched carefully to maintain hydration. Here again, if capacity is limited, it may be possible to reinforce the fluids with extra calories or protein. It is well to remember that seemingly small amounts of food and fluid, taken often, can add up to a surprising amount in the course of a day.

The role of food in supportive care of the advanced cancer patient should not be underestimated. The ability to eat and enjoy food is synonymous with life and health, and so the patient and his family will draw comfort from continuing attention to diet.

10. Elimination

Indwelling catheters may be needed for patients who are incontinent of urine. There are various rubber collection bags which can be worn by the patient during the time he is ambulatory. If these are not available a bottle can be used. Rubber or plastic protective pants, protective rubber sheeting and chair coverings may also be needed.

Catheters should be used only when necessary and must be changed frequently to avoid odor and infection. They should be kept patent at all times and care should be taken to avoid contaminating the catheter during irrigation or when it is being changed. If infection does occur it should be reported promptly so that treatment may be instituted at once.

Fecal incontinence is an extremely difficult nursing problem which may necessitate diapering of the patient as well as special protection of the bed and/or chairs. It may tax the ingenuity of everyone concerned to control intractable diarrhea. Constipation is perhaps more easily controlled by medications, enemas, and exercise.

11. Emotional and Psychological Aspects of Care

Both the patient and the family will react emotionally in some way to the patient and his illness. This interplay is very complex, and very often defies analysis. Studies would indicate that the observed behaviors or the verbalizations of both the patient and his family may mask strong emotions which are not expressed. For example, many patients find ways to deny their illness even when they have been told what they have. There is no one answer as to how one can help in any situation; this requires knowledge of each situation and the people involved.

It is often possible to gain help for the patient or family from other professional disciplines such as phychiatric social workers, nutritionists, clergymen, mental health consultants, etc. If these services are not directly available to the patient they may sometimes be obtained by the nurse on a consultation basis.