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hey should instruct them to wash their hands and perform other isolations control measures. The nurse should also be knowledgeable and be able to educate the patient about what to expect during and after the procedure. If the patient is about to undergo the procedure, it is the nurse’s duty to obtain informed consent, and make sure the patient understands what he or she is about to undergo. It may be beneficial for you to monitor the nutritional status of patients undergoing stem cell transplantation. Malnutrition may result from a multitude issues that arise during the procedure or from the underlying illness itself. Therefore, they should be screened by the nurse for malnutrition. These patients may also be on a low-microbial diet, because it reduces the risk of getting sick. The nurse can recommend foods that the client can eat while on this diet. For example, a patient should be taught to avoid unpasteurized dairy products such as soft cheeses (i.e. brie, camembert, goat) and to consume commercially packaged pasteurized cheeses (i.e. swiss, parmesan, monterey jack). Another treatment option for patients with NHL is immunotherapy, which boosts a patient’s immune system or utilizes man-made antibodies to fight cancer cells. Researchers recently did a study about the effectiveness of Brentuximab vedotin in the treatment of relapse and refractory NHL. Brentuximab vedotin consists of a man-made anti-CD30 antibody attached to monomethyl auristatin E (MMAE) an antimitotic agent. The drug attaches to CD30 on the surface of cancer cells, is internalized, and disrupts the microtubule network in the cell, arresting the cell-cycle and promoting apoptosis. Brentuximab vedotin is a relatively new drug and researchers wanted to test out its ability to treat NHL. Using a literature search, the researchers compiled data. The majority of data was collected from phase I and phase II trials, and case studies in which patients with refractory or relapsed NHL were treated with Brentuximab vedotin. They found a total of 359 patients that met these criteria and divided them into groups based on the pathology of their non-Hodgkin’s lymphoma: B-cell malignancies, T-cell malignancies, and non-B/T-cell malignancies. The researchers determined the effectiveness of using Brentuximab vedotin in the treatment of NHL, by measuring objective response rates, partial response rates, and complete response rates. Patients with B-cell malignancies (i.e. DLBCL, FL, PMBL, PTLD, GZL) showed an objective response (OR) of 51% and a complete response (CR) of 29%.Those with T-cell malignancies experienced an OR of 48% and a CR of 35%. Not enough information was gathered in the last group of malignancies to make a determination about the efficacy of treatment. The data shows that Brentuximab vedotin lead to significantly better outcomes in patients being treated for B-cell and T-cell malignancies. Therefore, researchers found evidence the Brentuximab vedotin was effective in treating these subtypes of non-Hodgkin’s lymphoma. A nurse treating a patient on Brentuximab vedotin should assess their patient for adverse reactions and side effects of taking the medication. These include peripheral neuropathy, anaphylaxis, tumor lysis syndrome, skin rash and PML. A nurse should monitor a patient’s CBCs to determine the degree of neutropenia. The nurse should educate the patient and their family about Brentuximab vedotin. Instruct them to notify the provider if they experience numbness or tingling in their hands and feet, or if they experience generalized muscle weakness. Teach them to be cognizant of the signs and symptoms of infection and to notify the provider immediately if they occur. If the patient is a female in childbearing years, they should be warned about the potential effect the drug could have on a developing fetus. Therefore, they should be advised to use contraceptives to avoid pregnancy. A mother should also be advised to avoid breastfeeding while on this drug.Alternative Treatment As stated previously, conservative cancer treatments such chemotherapy, radiation therapy, stem cell transplantation, immunotherapy and radioimmunotherapy have been thoroughly researched and proven to be effective in treating NHL. Although these interventions are most commonly used to treat NHL based on their efficacy, it is important to also take into consideration the various types of alternative treatments which are often overlooked. Alternative cancer treatments are non traditional forms of treatment including acupuncture, massage therapy, art therapy, music therapy, herbal medicine, body-based and mind-based therapy such as yoga and meditation, exercise and a healthy lifestyle. Although these treatments have not been proven to treat cancer independently, they have been proven to be effective in alleviating pain and common side effects of the disease and improving the quality of life of the cancer patient when introduced in conjunction with conservative cancer treatments. Pain management is an important consideration in the nursing care of patients with a cancer diagnosis who are being treated with conservative treatments. Considering the various medications these patients are taking and the side effects that come along with them, it is important to suggest alternative and therapeutic ways to help manage the pain these patients are experiencing.         In a systematic review of multiple research studies on rehabilitation interventions in palliative care for cancer patients, researchers concluded that acupuncture is most effective in treating the side effects of chemotherapy and radiation or any pain related to the disease (Abe, 2012). Although acupuncture has not been proven to slow the progression of the cancer or lower the mortality rate of the disease, it has been found to be an effective source of pain relief which improves the quality of life of patients with cancer. One study in the systematic review concluded that acupuncture was as effective as analgesic medication, while another study conducted by a different group of researchers found that acupuncture was more effective than medication. Although there are limitations present in previous studies regarding acupuncture as a conclusive cancer treatment, acupuncture was found to be effective in treating some level of pain related to cancer but further research needs to be conducted to determine whether acupuncture can replace analgesics during cancer treatment (Abe, 2012). Complementary traditional Chinese medicine, which includes acupuncture, massage and herbal medicine is another alternative treatment that was found to improve the survival rate in patients living with metastatic prostate cancer (Liu et al., 2016). In an 8 year long study involving 1132 patients with metastatic prostate cancer, Liu et al. (2016) found that prostate cancer patients who received traditional Chinese medicine (TCM) treatments for more than 50 days had a lower mortality risk and significant improvement in survival compared with non-users. In this study, 64.5% of participants were using traditional Chinese medicine treatments. Researchers concluded that traditional Chinese medicine was not only beneficial in relieving common symptoms of prostate cancer such as insomnia, hot flashes, and erectile dysfunction without common drug related side effects but it also improved the survival rate of prostate cancer patients in long-term follow-up (Liu et al., 2016). Although there was a positive correlation between TCM and prolonged survival rate in patient with metastatic prostate cancer it is important to consider the various factors that may contribute to lower mortality risk. Age, lifestyle, progression of the disease, demographics can all affect survival rate. In another study, the use of complementary and alternative medicine was observed in a pediatric/young adult population of cancer survivors living in New York. The results of this study showed that 115 childhood cancer survivors out of the 197 interviewed reported using some type of complementary or alternative medicine throughout their cancer treatment or following remission for up to 4 years (Ndao et al., 2013). Complementary and alternative therapies that were most commonly used among the cancer survivors in this study were relaxation and stress management, body-based and mind-body therapies such as yoga and meditation, and maintaining a healthy lifestyle through diet and exercise. These forms of therapy were reported to be used for relaxation and stress management and were reported to be effective by 62% of the subjects (Ndao et al., 2013). Although this study does not investigate the use of these therapies as a form of effective treatment for cancer in adolescents and young adults, results showed that complementary and alternative therapies are commonly used among childhood cancer survivors, whether referred by a parent or physician. These therapies were seen to be effective in promoting healthy lifestyles both physically and psychologically in cancer survivors to lower the recurrence of cancer in remission. Nursing implications when caring for patients with cancer who are either considering or participating in alternative therapies such as acupuncture, massage therapy, herbal medicine, yoga or meditation include proper education of the expectations of these therapies. Patient’s should understand that these treatments should be used in addition to and not in place of conservative treatments. Patient’s should also be aware that these alternative therapies may or not be effective depending on the progression of their disease and may only address one aspect of care including pain management, relaxation, quality of life, anxiety etc. Patients with Non Hodgkins lymphoma should be presented with the option of alternative therapies to alleviate their symptoms but should not be coerced into trying something they feel uncomfortable with. Assessing pain and overall well being, in addition to a complete physical assessment is important to determine the positive or negative effects of these alternative therapies. The psychological component of alternative cancer treatment is extremely important to consider. Creative arts therapy such as music therapy, dance/movement therapy and art therapy have been shown to have positive effects on cancer patients by allowing for emotional expression, increasing relaxation, promoting creativity and reducing anxiety to better manage symptoms of the disease (Puetz et al, 2013). As a result, these forms of alternative therapies have been shown to significantly improve the quality of life of patients diagnosed with cancer. The highest reduction in pain and the highest overall patient satisfaction following therapy was found in inpatient therapy groups who shared the same form of cancer (Puetz et al., 2013). In a systematic review of 10 clinical studies conducted on the effects of music therapy, positive improvements were found regarding patients’ relaxation, mood, and coping with the disease and cancer-related pain. The findings included positive expressions of emotion about the disease and the willingness to opening up to new goals (Boyde et. al, 2012). These studies were conducted on a large sample size, a wide age range and a variety of types of cancer diagnoses but did not specify a particular type of music therapy but rather allowed for musical expression of the individual. A study conducted by Bradt et. al (2014) examined the effects of music therapy in comparison to music medicine on the psychological outcomes and pain tolerance in cancer patients. Music therapy is considered interactive music making with a music therapist and music medicine is the act of listening to pre-recorded without the presence of a therapist (Bradt et. al 2014). 31 adult patients with a cancer diagnosis received two session of each type of music therapy. Based on the participants reports, researchers found a positive correlation between a boost in mood, decreased anxiety, increased relaxation, increased playfulness and creativity, decreased pain and a connection to self after the music sessions. Both mediums of music therapy were equal in achieving the targeted results; the one difference being 77.4% of the participants preferred the music therapy facilitated by a music therapist.  The data of this study indicates that music has a positive effect on symptom management, embodies hope for survival and helps connect patients with a cancer diagnosis to a pre-illness self. One negative outcome which is important to take into consideration with this type of therapy is that music may trigger memories of loss and trauma and therefore music selection should be assessed prior to use a therapeutic alternative. Participants who are open to this style of therapy treatment can benefit from it to aid in psychological health. The presence of a positive support group for individuals with cancer has also been proven to be extremely helpful in reducing anxiety and possible depression. In a study conducted by Björneklett et.al (2011) women within one year of a breast cancer diagnosis who received support therapy for one week following chemotherapy or radiation reported reduced anxiety versus women who were receiving standard follow up treatment. The measurement tool used was the Hospital Anxiety and Depression Scale (HADS).  This study was limited in data regarding a difference in depression between women receiving support therapy and standard treatment (Björneklett, 2011). As mentioned previously, it is important for the nurses caring for cancer patients who are either considering or participating in creative art therapy to provide proper education of the expectations of these therapies. These particular therapies should captivate the interest of the patient’s receiving them in order to have the greatest psychological benefit for the patient. The goal of creative art therapy is to allow for the expression of emotion, creativity and connecting to oneself pre-illness which may require encouragement from the nurse and medical team. These treatments aim to reduce anxiety and pain by increasing positive mood and relaxation and should be a conscious choice that the patient agrees on. Assessing pain and overall well being, in addition to a complete physical assessment is important to determine the positive or negative effects of these alternative therapies.Summary Non-Hodgkin Lymphoma is a heterogeneous disease that affects either B or T lymphocytes in the body. While it only affects a small amount of people in the world, there is a need for more research concerning the disease itself and treatment. Certain risk factors increase the risk of NHL such as: red meat consumption, viral infections like the Epstein-Barr virus, the use of hair dye before 1980, and benzene exposure.  It is especially important for nurses who have patients with NHL or have high risk factors; nurses must educate to decrease risk, prevent and properly take care of these patients. Fortunately, there are medical treatments for individuals with non-Hodgkin lymphoma. Chemotherapy, radiation therapy, stem cell transplantation, immunotherapy and radioimmunotherapy are some of the treatments patients can undergo. However, some treatments require certain criteria and others do

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