Category: Cancer

Introduction

According to the World Health Organization, cancer is one of the leading causes of morbidity and mortality in the world, which only continues to grow. Since 2012, the number of cancer patients has been increasingly growing, with over 14 million new cases appearing every year (WHO, 2017). At the same time, the number of cancer-related death exceeded that of 8.8 million since 2015 (WHO, 2017). The disease has been regarded as a worldwide healthcare problem for several decades now. As it stands, there is no effective cure for cancer in its later stages, and early cancer response and prevention remains the only response to the disease that has any chance of succeeding. However, the views on cancer and cancer prevention differ greatly across the countries. Even in the more medically and technologically advanced countries in Europe and the USA, there is a certain stigma associated with cancer.

Chemotherapy is viewed as a very dangerous and ineffective procedure that significantly shortens the overall lifespan and leads to numerous health complications in the future (Hilal et al., 2015). The situation is even worse in the Middle East, where religious views often interact with medicine and influence public opinion on cancer, cancer patients, and cancer prevention practices. This issue affects even the developed countries of the Arabian Peninsula, such as the UAE and the Emirates. Education, the understanding of mechanisms of the disease, possible influencing factors, and stereotyping all play an important role in affecting the populaces perception of cancer. Understanding the views of the population and the underlying issues behind cancer are paramount to developing a coherent and effective strategy to promote health and improve early prevention.

Statement of the Problem

The purpose of this research is to analyze the state of early response and prevention measures to cancer, as well as the populations perception towards cancer in the state of Oman, which is one of the prominent and economically prosperous countries of the Arabian Peninsula. The country possessed an all-encompassing and developed healthcare industry, which covers the majority of the population. At the same time, according to the Programme of Action for Cancer Therapy, Oman faces an almost two-fold increase in cancer incidence in the period between 2008 and 2020 (IAEA, 2013). Understanding the reasons behind such a drastic increase and improving the chances of early detection and response to cancer is thus paramount for the promotion of health in the Sultanate of Oman.

Methodology

The research will be conducted in the form of meta-analysis, which suggests a complex synthesis of all accredited and available sources of information pertaining to the subject. The information used in this study will be extracted from accredited scientific journals, official statistics, and official sites of major healthcare organizations such as WHO, PACT, and others. In addition, the research will feature the limited use of Omani national press releases, in the context of understanding and perceiving the views of the population towards cancer, cancer prevention, rehabilitation, and survival. The reasoning for using meta-analysis as the primary form of research, in this case, is formulated by the inability to travel to Oman and perform quantitative research and include the population of Oman in the research directly.

Hypothesis

The research hypothesis that the following study will be seeking to either prove or disprove states the following:

• Sultanate of Oman is facing a major cancer increase due to a multitude of factors, such as a change of lifestyle, as well as outdated views of the population on cancer prevention and cancer treatments, which are motivated by the local traditions as well as historical tendencies and religious views.

The null hypothesis, in this case, would be the complete opposite of the research hypothesis. As such, it would state that:

• The major cancer crisis currently faced by the Sultanate of Oman is not influenced by the change of lifestyle as well as outdated views of the population on cancer prevention and cancer treatments, which are motivated by the local traditions as well as historical tendencies and religious views. The growing incidence of cancer is motivated by other factors.

Scope and Limitations

The following meta-analysis is aimed to reflect on the situation with cancer prevention, early detection, treatment, and population perceptions of the disease in the Sultanate of Oman. While the results of this research can be extrapolated, to a degree, on other countries of the Arabian Peninsula, the research limits itself largely to the situation in Oman. Another limitation of this research comes from the format of the study. As this is qualitative literature research, it is limited in the use of sources. All information used in this research has been provided by someone else and did not come as a result of a direct quantitative study and research performed on the population of the Sultanate of Oman.

Another limitation of the study is that it reflects the attitudes and opinions of the population, as well as the overall situation in Oman in a yearly diapason between 2012-2017. As the situation may change in the following years due to the implementation of specific policies as well as the overall political situation in the country and region, the information provided in the following research may become outdated. After a certain period of time, it would require being reaffirmed and revalidated.

The recommendations were based on the information available for public use and possess a general connotation, not attached to any specific location within Oman. The emphasis on specific points mentioned in this analysis may change depending on the situation within particular communities.

Lastly, since this is a qualitative study, the conclusions and evaluations of the provided information may be subject to bias and misinterpretation.

Significance of the Study

This study has two purposes. The first purpose of this study is to develop practical recommendations that could be implemented by the Sultanate of Oman in order to reduce the incidence of cancer and promote early response and detection of the disease. This makes the research significant for any parties interested in the promotion of the health agenda within the country. In addition, the results of the research could be interesting to other countries in the Arabic Peninsula, as they share many similarities with Oman, including religion, healthcare practices, traditions, and mutual history.

Other than that, the results of the study could be invaluable to any researchers aiming to perform a quantitative study pertaining to the perception, attitudes and practice towards cancer early detection, prevention and survivorship in Oman. The research could provide a suitable theoretical and informational framework to be used as a starting point for the formulation and development of said study. The accumulation of relevant sources may enable future researchers to locate and use them in their own endeavors, thus promoting interconnectivity within the medical, scientific community.

Lastly, the research helps create a scientific and historical continuity to the subject of managing and treating cancer in Oman, as it reflects on the progression of the public perception and methods of prevention and treatment of the disease in 2012-2017. In the future, this information would allow tracing said progression in the scope of a wider, all-encompassing review.

Literature Review

The dynamics of cancer incidence in the Middle East differ from those in Europe, the USA, or the Far East, due to a unique combination of factors affecting the situation in these countries. The study performed by Hilal et al. (2015) is dedicated to prostate cancer, yet the results of this study could be extrapolated on the entirety of the region concerning other types of cancers as well. The study found that the factors affecting cancer rates in Arab countries, such as Oman, include the relatively young age structure, lower androgen and antigen levels in Arab men, the metabolic syndrome paradox, and the effect of the Mediterranean diet patterns, which are prevalent in the region. The study suggests that a variety of regional and country-specific factors could be causing or preventing the spread of cancer in Oman, at least, as far as prostate cancer is concerned. It highlights the positive effect of the Mediterranean diet that includes many vegetables, grain, and low amounts of fat, as one of the positive factors that prevent the apparition of cancer in Arabs. At the same time, it provides important information on genetic predisposition of the population towards particular kinds of cancer.

Breast cancer is considered to be among the most common types of cancers associated with women. A study published by Miri Cohen in 2013 reflects on the cultural perceptions of breast cancer among Arab women in Israel. According to Cohen (2013), Arab women in Israel have a low early screening attendance rate when compared to other groups of patients. Non-attendance is largely associated with personal religious views and beliefs in regards to healthcare, in particular, the health belief model, which states that perception of a disease will inevitably lead to one, thus provoking a reaction of not attending cancer screenings out of fear that it may provoke a disease. The research also showed a disparity of views towards cancer as a healthcare problem, ranging widely from traditional towards modern and integrated medical views on the subject, the latter being motivated by education and family background. The major supporting factors contributing towards survival and the desire to live among Arab breast cancer patients were concluded to be familial support, which is common due to the collective and clustered nature of Arab families, as well as religious guidance. This study is important in the scope of our research due to the fact that it reflects on Arab women in highly developed hospital settings, which are compatible to those in the Sultanate of Oman. At the same time, any information related specifically to Israeli healthcare was not used in the following discussion due to apparent differences between the two countries, the state religion, and the approach towards healthcare.

Oman is not the only state among the countries of the Arabian Peninsula that had experienced a gradual increase in cancer incidence. Other developed countries in the region, such as Qatar, have also experienced the same problem, which was largely motivated by the changes in lifestyle and the increasing westernization of the youth, as well as dietary changes and climatic alterations perceivable across the world. Donnely et al. (2013) find that the main factors for women not attending cancer screenings were a lack of doctors recommendation, fear, and embarrassment. All of these are culturally-motivated factors, stemming from the highly personal nature of cancer and the fear of being looked upon as diseased among Arab women. The results of this study correlate with the findings presented by Cohen (2013) pertaining the attitudes of Arab women towards cancer screenings in Israel, thus showing a cultural pattern of the issue being viewed as taboo. Unlike Israel, however, Qatar bears more similarities to Oman in terms of quality and national identity of healthcare, due to both being Arab nations. The results of this research show that the cultural views on cancer screenings in women remain similar across several countries in the Middle East and are largely motivated by cultural and religious homogeneity.

The ability to recognize symptoms of cancer is considered paramount to the efforts of early prevention of cancer, especially in countries such as Oman. At the same time, despite the overall level of healthcare being relatively high, especially when compared to the low-income and middle-income countries of the region, Oman has a surprisingly low level of public awareness of warning signs and symptoms of cancer. This could be a potential factor to contribute to the growing cancer incidence and mortality rates in Oman. A survey performed by Al-Azri et al. (2015) showed a surprising rate of ignorance in regards to the subject among Omani men and women aged 18 and older. According to the survey, total awareness of the participants who took the CAM (Cancer Awareness Measure) questionnaire amounted to 40.6%, which is very low. The survey managed to identify the major cultural, practical, and emotional barriers among the respondents. The most widespread barriers included the fear of the doctor actually finding any symptoms of cancer (65.6%), and the inability to talk the doctor about cancer (46.1%). The most common practical barrier to screening tests involved the inability to make the time for an appointment due to work and general business (75.1%). The study also showed that women were more likely to avoid medical help due to fear, shame, and embarrassment. This study highlights a major barrier for the Omani healthcare  as even the most efficient medical systems are powerless against cancer if it is reported too late. The research by Al-Azri et al. (2015) states an urgent need for the Sultanate of Oman to improve the public awareness and knowledge of cancer if the incidence and mortality rates for cancer are ever to go down. The results of this research resonate with other survey findings done in other countries, highlighting the fact that public healthcare in countries of the Arabian Peninsula has advanced faster than the public knowledge and perception of it.

Another study performed by Mohammed Al-Azri in 2016, titled Delay in cancer diagnosis: Causes and possible solutions addresses the necessity of early detection in cancer treatment. According to the researcher, cancer has a reasonably high treatment rate if addressed at the early stages of development. However, the more the disease progresses, the more likely it is for treatments to fail. Al-Azri reflects on the results of the CAM survey performed by him and his team in 2015 and states that one of the main reasons for delays in cancer diagnosis is related to the educational system of Oman. Although the standard school curriculum features extensive information about cancer, it never addresses any practical means of self-diagnosis and description of the symptoms, which is especially true for breast cancer. This conclusion resonates with the findings of the other researches mentioned in this list. However, Al-Azri highlights another problem that is more relevant to Omani healthcare system as a whole. The hospital system in the countries of the Arabian Peninsula is surprisingly uniform and consists of a network of local health centers and hospitals. Primary healthcare centers are supposed to identify possible symptoms of cancer and direct the patients for a more in-detail screening to a better-equipped facility. This creates a delay, which has the potential for further complications. In addition, the early diagnosing system is far from perfect, as the patient is often required to travel in order to get a second opinion, sometimes even abroad. This creates a loop in the continuity of care, which, in turn, causes delays and complications, reducing the probability of successful treatment.

Faith has a major influence on the people of Oman, and on Arabs in general, as Islam is the dominant religion in the region. According to the study conducted by Albar (1994), Islam as a religion strives to protect its tenants against cancer by prohibiting certain products and activities associated with cancer. For instance, Islam prohibits the use of tobacco, whether in smoking or chewing. Tobacco is known to be a major cancerogenic substance, responsible for the majority of lung cancer incidents around the world. At the same time, Islam prohibits excess in food consumption, as well as the consumption of certain fat-saturated meats, such as pork. Thus, it contributes to the overall healthiness of Arabs and acts as a preemptive measure against cancer. While this effect of the faith can be considered as positive, Islam may have a negative effect on early response and treatment to the disease.

This is due to the fact that the Quran sends several controversial messages in regards to diseases, which may have different effects and interpretations. For instance, Islam teaches not to fear death because our time on this plane of existence is short and that the soul is immortal, while the body is not. At the same time, Quran states that Allah sends troubles and misfortunes upon his servants to test their faith, and rewards those who patiently persevere. Lastly, according to Albar (1994), faithful Muslims who die of disease are considered martyrs in the eyes of Allah. These three factors, in combination, may lead the population to a conclusion that in order to ascend to a different plane of existence, they must not prolong their time in this world, and not seek treatment for cancer even at the stages when they could still be saved. While it is their personal decision, it does not help decreasing the incidence or morbidity of the disease.

The mass media play an important role in the promotion of health and education, as well as in forming the public opinion towards cancer prevention, cancer screenings, and cancer survivorship. Cancer survivorship, in particular, is being viewed as an example of fortitude, bravery, and dedication to life. A good example of this trend is a news article featured in Times of Oman, which tells the story of Doaa Elseoud, who was named the most inspiring cancer survivor in Oman (Afifi, 2017). In the interview regarding her survivorship, Doaa covers very important aspects of fighting cancer on an individual level  the importance of the support of friends and family, the importance of self-examination and early prevention, the value of discipline in enduring prolonged cancer treatments, as well as the positive influence of the Faith in her recovery (Afifi, 2017). She also touches the issue of cancer survivorship in Oman and other Arab countries, stated that there is an issue of perceived shaming of cancer survivorship. This causes many women to hide the signs of being treated, such as covering their heads when undergoing chemotherapy and not disclosing the issue with anyone, even close friends and family, thus denying themselves an important source of emotional support (Afifi, 2017).

Prospects for Oman to improve its cancer incense and survival rates are positive, however. The country is making an effort into solving the problems associated with cancer through higher quality of healthcare and the all-encompassing program of disease prevention. According to Times of Oman, since 2015, Oman has become the cancer-prevention body hub  an initiative that stretches beyond the borders of one single country, instead aiming to encompass the entire region. Other countries to partake in this effort are Kuwait, Bahrain, Saudi Arabia, Ethiopia, Kenya Tanzania, Egypt, Zambia and Tunisia (Blesson, 2015). This initiative involves cooperation between different healthcare systems in order to establish a united patient database, which would allow for faster sharing of data and result in the improved rates of cancer detection and prevention. The countries acknowledge the need for better disease prevention at the early stages due to the fact that chances of survival during the 3rd and 4th stages of cancer are extremely low (Blesson, 2015). The most common types of cancer for Arabic countries are stated to be breast cancer for women and prostate cancer for men. Cancers associated with the cardiovascular system are also becoming more common due to changes in lifestyle and diet (Blesson, 2015).

Discussion

After thoroughly reviewing the data assembled in the course of this research, it is possible to construct a cohesive picture of the situation in regards to perception, attitudes, and practice towards cancer early detection, prevention, and survivorship in Arab countries and Oman. This discussion will mostly focus on the identified problems found in the healthcare system and the public perception of the problem.

Although the country is stated to possess a highly developed healthcare system that is competent and well-equipped for handling cancer patients at all stages of development, the current system lacks the optimization required for a quick diagnosis of the disease. This is supported by Al-Azri (2016), who states that cancer incidence rates largely depend on how quickly they are diagnosed. The current system does not offer any effective ways of getting a second opinion on the diagnosis, which causes delays in the treatment and hurts the continuity of care.

The most common types of cancer encountered in Oman, and other countries of the Arabian Peninsula are breast cancer, prostate cancer, and cardiovascular cancers. This statement is supported by Hilal et al. (2015), Cohen (2013), and Donnely et al. (2013), who state that the Arabs are vulnerable to this particular type of cancer due to genetics, choices of food, changes from one lifestyle to another, pollution, and cultural barriers. Breast cancer is prevalent in women, while prostate cancer  in men.

The main mechanism of cancer detection and prevention, which is public awareness and education, is very poorly developed in Oman and other Arab countries. This data is supported by Al-Azri and his CAM survey conducted in 2015, as well as by other sources, to various degrees. The Omani system of healthcare education fails on all levels, from government programs to individual efforts performed by doctors and nurses. Cohen (2013) and Al-Azri (2016) both indicate that in many cases the doctors fail to convey any information about cancer to the patients. The school curriculums in Oman, while dedicating some attention to explaining the mechanisms of cancer, do not pay enough attention to describing the major symptoms and methods of self-diagnosis, which contributes to the lack of early diagnosis and prevention efforts.

The population in Oman and in other Arab countries expresses a wide range of opinions in regards to cancer detection and prevention. These range from traditionalist to modern biomedical perceptions and highly dependent on the personal background of a particular patient (Cohen, 2013). Despite this, the majority of the population in Oman have a skewered perception of cancer prevention, detection, and survivorship, which is demonstrated in feelings of fear and shame in patients, who are reluctant to undergo screenings (Donnely et al. 2013). This fear is associated with incomplete knowledge of what cancer is and how it is treated. The common stereotype is that cancer is largely incurable and that chemotherapy is a long and unhealthy procedure that makes a person suffer more in the long term. These beliefs are connected to the issue of cancer education, which was already mentioned in the previous section, and the absence of knowledge is thus replaced with rumors and stereotypes. In the Arab society, which is largely dominated by males, women feel particularly conscious about their health and appearance, and to them, cancer is associated with being diminished in value as a woman and a person, which leads to avoidance of cancer screenings and treatments (Donnely et al., 2013).

At the same time, the Arab society views cancer survivorship as something that a person should be hiding and ashamed of. Many cancer survivors are stated to hide the fact that they underwent chemotherapy, masking the signs of treatment underneath the clothes or under blankets overhead. Baldness, associated with patients that underwent chemotherapy, is shunned, particularly by women, who are expected to have long hair. This tendency, however, is a subject to changing, as more progressive views come into Oman and other Arab countries. The story of Doaa Elseoud showcases this trend, as cancer survivors are being turned from a shunned topic into becoming the symbols of bravery, endurance, and determination to live (Afifi, 2017).

The Islamic faith is stated to have an immense influence on Omani population, as well as on the populations of other Arab countries. However, this influence is controversial, as Islamic texts tend to have contradictory connotations, some of which have a positive meaning, while the others are detrimental to the acceptance of cancer treatment and all the necessary screenings. According to Albar (1994), Islamic faith tends to have a positive connotation in the prevention of cancer and promotion of a healthy way of life, while at the same time a negative connotation in regards to the acceptance of the disease and willingness to depart to another world, rather than clinging for life. The difference between undergoing necessary treatments and clinging to life is not explained clearly enough (Albar, 1994).

These are the major issues with the public opinion and the general state of Omani healthcare industry in regards to cancer prevention, detection, and survivorship. The following recommendations would address the issues identified in the discussion section, and describe the ways of how these issues could be overcome.

Conclusions and Recommendations

The following recommendations are to address the problem of early cancer prevention and detection by making improvements in the key areas and involve key stockholders that represent the healthcare industry, the government, and the Faith. Together, these stockholders are to adopt a complex and all-encompassing approach in order to improve cancer incidence and morbidity rates.

The first step that needs to be taken involves the promotion of healthcare education on all levels, ranging from schools to individuals. The curriculum must be revised in order to include the basics of self-examination and the major symptoms of cancer. In addition, all healthcare providers, from primary healthcare providers to major hospitals, to enroll in periodic information campaigns to inform the population about the dangers of cancer, major cancerogenic factors, self-care and self-diagnosis techniques, as well as major symptoms. The promotion of screening tests is encouraged. Screening tests should be subsidized by the Omani government in order to encourage the population to undergo them. These measures, when combined, would help shift the viewpoint of the Arabic population from traditional (which contains many harmful stereotypes) towards biomedical, which should improve the screening attendance rates and the overall attitude towards medical procedures.

Members of the Faith communities will play a paramount role in promoting a more positive attitude towards cancer detection, prevention, and survivorship. The leaders of Muslim religious communities must explain to their members in no uncertain terms that there is nothing shameful or wrong with screening tests and that not fighting for survival and doing everything in their power to live is against the will of Allah. One of the ignored tenets of Islam faith states that it is a sin against God to take ones own life or to perform actions that would, in the end, lead to the termination of life. Inaction against cancer could be considered just that  a termination of life.

Social services, medical personnel, and faith communities are to work together in order to change the public opinion towards cancer detection, prevention, and survivorship in Oman. Working through mass-media and other available channels, it would be possible to improve the attendance to screenings and reduce the social stigma that follows cancer patients and cancer patients alike. Education is the answer. If the situation remains as it is, it is bound to get worse and lead to increased mortality and morbidity rates among the population.

References

Afifi, S. (2017). Doaa Elseoud: Meet the inspiring cancer survivor in Oman. Web.

Al-Azri, M.H. (2016). Delay in cancer diagnosis: Causes and possible solutions. Oman Medical Journal, 31(5), 325-326.

Al-Azri, M.H., Al-Hamedi, I, Al-Awisi, H., Al-Hinai, M., & Davidson, R. (2015). Asian Pacific Journal of Cancer Prevention, 16(7), 2731-2737.

Albar, M.A. (1994). Islamic teachings and cancer prevention. Journal of Family & Community Medicine, 1(1), 79-86.

Blesson, M.M. (2015). Oman to be cancer prevention hub. Web.

Cohen, M. (2013). An integrated view of cultural perceptions of cancer among Arab people in Israel. Health Psychology Review, 8(4), 490-508.

Donnely, T.T., Al Khater, A.H., Al-Bader, S.B., Al Kuwari, M.G., Al-Meer, N., & Fung, T. (2013). Beliefs and attitudes about breast cancer and screening practices among Arab women living in Qatar: a cross-sectional study. BMC Womens Health, 13(49), 1-16.

Hilal, L., Shahait, M., Mukherji, D., Charafeddine, M., Farhat, Z., & Shamseddine, A. (2015). Prostate cancer in the Arab world: A view from the inside. Clinical Genitourinary Cancer, 13(6), 505-511.

IAEA. (2013). Sultanate of Oman faces the growing cancer burden. Web.

WHO. (2017). Cancer. Web.

Cancer Care

Global spending on medical care is a major fiscal challenge in many countries. According to Brenner (2002), expenditures for terminal diseases will increase tremendously in the coming years. According to Brenner (2002), the number of cancer patients is on the rise. This is true because more citizens are getting older in the country. Every innovation or new technology seems to increase the cost of diagnosing and treating cancer. The government should reconsider the best practices towards providing high-quality and affordable cancer care to every patient. This essay describes the diagnosis and staging of cancer. It also highlights three complications associated with cancer. The discussion offers a detailed approach towards better care of cancer.

The current cost of cancer care makes it impossible to address the needs of different patients. Many cancer patients cannot afford quality medical services for cancer. This explains why all stakeholders should work together to minimize the costs of cancer treatment. These stakeholders should ensure every patient receives quality and affordable cancer care. Cancer care is a dynamic practice that calls for proper coordination and support (Balogh et al., 2013, p. 54). Clinicians and caregivers should understand the best practices to provide better care to every cancer patient.

Diagnosis and Staging of Cancer

Doctors examine the presence of cancerous cells by looking at the affected tissues. This is done using a powerful microscope (Balogh et al., 2013). A biopsy involves the removal of small pieces of the affected tissues. The doctor uses a powerful microscope to examine the infected tissue. This procedure informs the doctor whether there are cancerous or benign tumors in the tissue (Brenner, 2002). Doctors can use three methods to remove body tissue for examination. The first process is endoscopy. This process entails the use of a lighted tube to examine internal body areas or organs. Needle biopsy occurs when the doctor takes some tissue samples from the infected areas. A clinician inserts a sharp needle into the suspected tissue or area. Doctors can also use surgical biopsies to remove tumors (Balogh et al., 2013). The next stage is determining the hostility of cancer.

Staging helps the doctor identify the stage of cancer. The results obtained help the doctor make the relevant treatment decisions. Cancer has four unique stages. The first stage is in situ whereby cancer has not spread to other body organs or tissues. The local stage is whereby the cancer is in its original organ. The regional stage occurs after the disease attacks new organs or lymph nodes. The distant stage occurs when cancer has spread to different body systems or organs (Balogh et al., 2013). The stage of the condition dictates the effectiveness of the treatment process.

Three Complications of Cancer: Side Effects and Lessening Psychological and Physical Effects

The patients health and age determine the complications associated with the condition (Brenner, 2002, p. 1132). Such complications can be life-changing and painful. The first complication can be either emotional or mental. Cancer patients may develop mood disorders, anxiety, or depression. Some patients will become sad and disoriented. This explains why many patients try to commit suicide. The second one is a physical complication. One example of this complication is pain. Cancerous cells will spread to other tissues and organs. This process causes a lot of pain or discomfort. Pain can be neuropathic, somatic, or visceral (Brenner, 2002, p. 1133). The third complication is metastasis. This complication occurs after the condition infects other body tissues or the lymphatic system. This complication causes death because the cancerous cells attack vital organs such as the brain.

Doctors treat cancer using chemotherapy and radiation. These treatment methods produce some side effects. Radiation therapy causes short-term side effects. Some of these side effects include irritation, throat pain, discomfort, and hoarseness (Thirumala, Ramaswamy, & Chawla, 2009, p. 73). Some long-term effects might include jaw pains, cavities, and damage to salivary glands. Chemotherapy can also result in nausea and hair loss. The method also weakens the bodys immune system (Brenner, 2002). Most of these short-term side effects disappear after treatment.

Psychotherapy and support groups can help patients lessen the psychological effects of cancer. The practice can help many patients manage stress and depression. The patients can also consult their doctors and counselors to overcome these effects (Thirumala et al., 2009). Every doctor should identify the source of pain before providing the best medication. The practice will help more patients manage pain. Some useful medications for pain include opioids such as oxycodone, morphine, and codeine.

Important Lessons

The above practices are essential for diagnosing and treating cancer. Doctors and clinicians can increase the quality of healthcare to obtain better results. Nurses should always provide better outcomes for cancer patients. Clinicians should also provide timely and accurate information to their patients. This will become a critical aspect of high-quality and timely care. Clinicians should also consider the best practices in order to deliver quality care (Brenner, 2002). Every hospital should use the best practices in order to lengthen survival. The government should encourage the use of EMRs in order to offer evidence-based cancer support. More studies will help clinicians address the health needs of many cancer patients.

Reference List

Balogh, E., Bach, P., Eisenberg, P., Ganz, P., Green, R., Gruman, J.,& Ya-Chen Shih, T. (2013). Practice-Changing Strategies to Deliver Affordable, High-Quality Cancer Care: Summary of an Institute of Medicine Workshop. Journal of Oncology Practice, 9(6), 54-59.

Brenner, H. (2002). Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet, 360(1), 1131-1135.

Thirumala, R., Ramaswamy, M., & Chawla, S. (2009). Diagnosis and Management of Infectious Complications in Critically Ill Patients with Cancer. Critical Care Clinics, 26(1), 59-91.

Melanoma is a type of skin cancer caused by the uncontrolled growth of melanocytes (American Cancer Society, 2021). It most commonly appears on the legs for women and the chest and back for men but also can occur on the other parts of the human body in the form of black or brown patches. Although melanoma accounts only for 1 percent of all skin cancer cases, it is found to be the most deadly among them as it is likely to spread if not cured in time. Currently, the treatment options for this disease include surgery, immunotherapy, chemotherapy, radiation therapy, and targeted drug therapy.

Ewing Sarcoma is a type of cancer that grows in the bones or the soft tissue. Most commonly, it is diagnosed in the legs, arms, spine, ribs, or pelvis. Despite being the second most prevalent type of bone tumor, it occurs quite rarely. Generally, the survival rate of children diagnosed with Ewing Sarcoma reaches approximately 70 percent if the disease is treated on time (St. Jude Childrens Research Hospital, 2021). Otherwise, cancer can spread and, thus, increase the chances of a young patients death by more than twice. The treatment of this disease is partly similar to the treatment of melanoma and includes radiation therapy, surgery, and chemotherapy.

Arthritis refers to the disorder that appears in the joints or tissues surrounding the joint. It is characterized by pain in the affected areas and stiffness. As there are more than 100 types of this disease, the reasons that can cause it may vary (Centers for Disease Control and Prevention, 2021). However, the specialists suggest the common risk factors that may increase the possibility of arthritis occurrences, such as for overweight and obesity, infectious viruses and bacteria, joint injuries, frequent knee bending and squatting, and smoking. The most common types of the disease include osteoarthritis, rheumatoid arthritis, and gouty arthritis. The former is characterized by degenerative processes in the joints and bones caused by cartilage destruction. The second is an autoimmune disorder that occurs due to immune system attacks on healthy cells leading to inflammation and pain. Finally, gout is an inflammatory type of arthritis that is considered to be very painful. Usually, patients suffer from a swollen joint and recurrent feeling of heat in the affected part.

Works cited

About Melanoma Skin Cancer. American Cancer Society, 2021.

Arthritis. Centers for Disease Control and Prevention, 2021.

Ewing Sarcoma. St. Jude Childrens Research Hospital, 2021. Web.

The study of clinical states in cancer patients is of fundamental importance for medical sciences. For example, it is well established empirically that one of the central manifestations of cancer development is pain. Research data show that more than half of cancer patients report pain (Dalal & Bruera, 2019; Durham, Strassels, & Pinsky, 2021; Scarborough & Smith, 2018). In fact, current advances in medical science have reached the point where the life expectancy of cancer patients is rapidly increasing (Jiang et al., 2019). For example, citing a 40-year study, Scarborough and Smith (2018) reported that 64% of patients with metastatic cancer typically report pain, and another 59% of those currently undergoing anti-cancer treatment also report pain. In addition, one-third of patients report pain even after completing treatment. As a consequence, practical pain assessment and treatment is essential for cancer therapy to improve the health status of cancer patients. Available research evidence supports that pain management significantly improves the vital signs of cancer patients (Charoenpol et al., 2019; Dalal & Bruera, 2019; Durham et al., 2021; Fan et al., 2017). In contrast, inadequate pain control is associated with decreased social life and low social support.

There are different pain management strategies for cancer patients. First and foremost, the primary method of pain management for cancer is the use of opioids (Dalal & Bruera, 2019; Durham et al., 2021). For many years, the choice of this method has been based on personal choice, but recent evidence suggests a number of emerging problems. One major problem is opioid dependence (Durham et al., 2021; Dalal & Bruera, 2019). Furthermore, according to Dalal and Bruera (2019), recent evidence shows that cancer patients are also at risk for non-medical opioid use due to emerging addiction. Due to the increase in opioid-related deaths, the Centers for Disease Control and Prevention (CDC) issued new guidelines to limit opioid use, which also led to limited access for cancer patients (CDC, 2021). In addition, one-third of patients who continue to take pain medication still report pain, raising questions about the effectiveness of opioids when used alone for pain management. These problems and the critical role that effective pain management plays in improving the life outcome of the cancer patient require the development of new pain management strategies.

One new strategy is to keep a pain journal or diary. First and foremost, pain diaries are a self-assessment tool in which a person records his or her pain sensations and their management (Smith, 2021). Physically, it is a paper journal  or notebook  or a virtual platform in which the patient does reflective work in order to describe their pain sensations during therapy. Moreover, the pain diary assists in pain management by helping patients identify the nature of pain, where it is localized, and the impact of different management strategies to determine the most appropriate strategy for managing a particular pain (Smith, 2021). As a result, the completed pain diary represents the dynamics of pain development or inhibition during the entire treatment , including the postoperative recovery phase. Consequently, an experienced clinician can use these records to assess the subjective experience of the patient and, when scaled up, the entire patient sample to evaluate the effectiveness of clinical programs and improve the quality of care provided.

Since the pain diary is a relatively new method of assessment, the study of this phenomenon has well-deserved popularity among the academic medical community. In fact, journaling is a fantastic combination of pedagogical reflection and self-management methods, therefore, it is inappropriate to consider the use of these strategies as an option for medical treatment. Nevertheless, this does not mean that there are no tangible results from the practices undertaken. More specifically, Rosti (2017) has shown that the use of self-management techniques and the context of effective patient-doctor communication is the best narrative medicine strategy. To put it another way, such solutions allow one to critically evaluate what the patient is experiencing during therapy and then use that to adjust the individualized plan. In cancer pain, a study by Fan et al. (2017) showed that pain-based self-management improves patient pain and improves medication compliance in cancer patients. At the same time, ElMokhallalati et al. (2018) proved that pain intensity tends to decrease when the patient engages in self-management of his/her condition and clearly understands the essence of the actions performed. This has also been confirmed by Howell et al. (2017), who proved that such strategies not only improve clinical progress but also reduce the number of medical services required and thus significantly offload the busy clinical agenda of oncology facilities. Consequently, this together can show the high reliability of reflective practices.

Contextual studies of the effectiveness of using pain diaries  or pain notes  are as critical as studies of self-management systems. For example, Erol et al. (2018) were able to show the critical need for nursing support for the patient to become familiar with the possibility of fixing their pain. In other words, the patient can hardly come to fill out a pain journal on his or her own, so it is critical to provide a little training for this. The issue of training has also been raised in a study by Koh et al. (2018), which demonstrated that familiarizing the patient with the pain logging system  in other words, the ability to log pain at different stages of therapy  was influential in reducing overall pain and reducing recovery time. Moreover, in their study, Charoenpol et al. (2019) studied the effect of pain diary on intensity, interference, and intrapersonal changes in patients with general pain: the results showed a decrease in pain intensity at four weeks. This significantly improves the quality of cancer pain management. However, there are very few studies on cancer pain management using pain diaries, which means that this area is understudied. The studies reviewed have shown promising results, and there is a need for more experimental research in this area.

References

CDC. (2021). About CDCs opioid prescribing guideline. CDC Opiods. Web.

Charoenpol, F., Tontisirin, N., Leerapan, B., Seangrung, R., & Finlayson, R. (2019). Pain experiences and intrapersonal change among patients with chronic non-cancer pain after using a pain diary: a mixed-methods study. Journal of Pain Research, 12, 477-487.

Dalal, S. & Bruera, E. (2019). Pain management for patients with advanced cancer in the opioid epidemic era. American Society of Clinical Oncology Educational Book, 39, 24-35.

Durham, D.D., Strassels, S.A., & Pinsky, P.F. (2021). Opioid use by cancer status and time since diagnosis among older adults enrolled in the Prostate, Lung, Colorectal, and Ovarian screening trial in the United States. Cancer Medicine, 10(6), 2175-2187.

ElMokhallalati, Y., Mulvey, M. R., & Bennett, M. I. (2018). Interventions to support self- management in cancer pain. Pain Reports, 3(6), 1-4.

Erol, O., Unsar, S., Yacan, L., Pelin, M., Kurt, S., & Erdogan, B. (2018). Pain experiences of patients with advanced cancer: a qualitative descriptive study. European Journal of Oncology Nursing, 33, 28-34.

Fan, Z.Y., Lin, J., Li, X., Chen, X., & Huang, X. (2017). The effect of pain self-management based on pain control diary on breakthrough pain. Journal of Clinical Oncology, 35(15), 10107-10107.

Howell, D., Harth, T., Brown, J., Bennett, C., & Boyko, S. (2017). Self-management education interventions for patients with cancer: a systematic review. Supportive Care in Cancer, 25(4), 1323-1355.

Jiang, C., Wang, H., Wang, Q., Luo, Y., Sidlow, R., & Han, X. (2019). Prevalence of chronic pain and high-impact chronic pain in cancer survivors in the United States. JAMA oncology, 5(8), 1224-1226.

Rosti, G. (2017). Role of narrative-based medicine in proper patient assessment. Supportive Care in Cancer, 25(1), 3-6.

Scarborough, B. & Smith, C. (2018). Optimal pain management for patients with cancer in the modern era. CA Cancer Journal Clinic, 68(3), 182-196.

Smith, Y. (2021). Using a pain diary. News ML. Web.

Introduction

Different from other illnesses, cancer is characterized by significant pain, survival risks, distress, and emotional breakdown. The disease has adverse effects not only on patients but also on entire family members as well as those closely connected with them. The cases of cancer in all countries worldwide seem to be escalating every day. The American Cancer Society (n.d) indicates that 1.8 million new cancer cases and 606,520 cancer deaths are reported in 2020, figures that are estimated to be 1.9 million and 608,570, respectively, in 2021. All individuals, regardless of their age, gender, or geographical location, are vulnerable to this deadly disease.

Patients, family members, and friends spend a considerable amount of money on the treatment and management of cancer. However, cancer insurance is the best companion to managing cancer care costs. An evaluation of what cancer insurance is, what it covers, how it works, the best providers, and how it differs from health insurance can facilitate a better understanding of the policy and its benefits.

Cancer Insurance, What It Covers, and How It Works

Cancer insurance refers to the insurance policy that pays a lump sum in the case holders are diagnosed with cancer disease. Payouts related to these insurance plans range significantly depending on premiums. Cancer insurance plans are not different from critical sicknesses policies (What is a cancer insurance policy? n.d.). However, the plans are only limited to cancer diagnoses, unlike the critical illness policies that cover a broader array of ailments.

Cancer insurance policies do not serve as a stand-alone coverage; instead, they are designed to appendage regular health insurance plans. Patients can use payouts from these policies to cover out-of-pocket expenses under other medical insurance plans and other costs associated with cancer treatment. Although the coverage of cancer insurance plans varies according to policy details and providers, most of them cover medical and non-medical costs. The policies become effective after insurance companies receive documents that show that their clients have been diagnosed with cancer.

Popular Cancer Insurance Providers

Aflac

Aflac is the largest supplemental insurance provider in the United States that has been operating since 1955. The companys cancer insurance policy is available directly to individuals or through employers, and the coverage is portable. Aflac categorizes the benefits of cancer wellness, cancer diagnosis, cancer treatment, hospitalization, continuing care, and transportation, among others. While wellness benefits encompass $75 annually for only one cancer screening service received by covered individuals, the amount the company pays for others varies significantly depending on care or amenities rendered (Aflac Supplemental Insurance, n.d.). The premium paid by covered individuals varies according to the plans they select. Equally, copayments or deductibles are not clearly defined since they are influenced by the plans chosen by customers.

All individuals who have not previously been diagnosed and treated with cancer or have pre-existing conditions that increase risks for the disease are eligible for the Aflac cancer insurance policy. Clients are required to have registered for regular health insurance plans and contribute their premium monthly. Major advantages for Aflac are that this provider pays for initial diagnosis, covers experimental treatments, and does not provide an age limit for eligibility (Aflac Supplemental Insurance, n.d.). However, the possible exclusion for illnesses reported within the past ten years and lack of disclosure of what policy covers unless a client signs for one are key shortcomings.

Cigna

This provider is a well-established insurance firm in the United States, popular in health and dental benefits. The company provides its clients with modifiable coverage such as stroke and heart attack plans in addition to lump-sum cancer insurance. Cigna offers two types of cancer policies that customers can choose from, cancer care treatment and lump-sum payment policy. Benefits associated with purchasing Cignas cancer insurance are for chemotherapy, hospitalization, surgical procedures, rehabilitative therapy, transportation and lodging, family care, hospice care, and extended care facility stay (Cancer Treatment Insurance, n.d.). While Cigna advertises that the monthly premium for comprehensive cancer insurance is $19, the amount varies based on the number of individuals covered as well as the benefit amount.

There are no fixed copayments or deductibles since they are determined by the policy purchased by customers. Eligibility and requirements include one to have 18 up to 99 years, no pre-existing illness increase risks for cancer, and not previously been diagnosed treated with cancer (Cancer Treatment Insurance, n.d.). Additionally, customers have to sign for regular health insurance. According to Hunt and Figat (2021), Cignas cancer insurance advantages include benefits amounting from $5,000 to $100,000, availability of recurrence coverage option, and are easier to receive a quote online. Nevertheless, a waiting period of 30 days, coverage reduction by 50 % when one reaches 65 years, and payment of benefits only for the first 30 days when a client is hospitalized are major setbacks.

Physicians Mutual

This provider has been operating since 1902, offering insurance products to individuals as well as workers in small businesses. The companys cancer insurance policy is categorized into two plan types for the clients to choose from, paying varying percentages of cancer-related costs. Benefits associated with the firms cancer insurance include preventive care screening, chemotherapy, radiation, hospitalization, inpatient prescription, immunotherapy drugs, experimental treatments, transportation, and lodging (Cancer insurance | affordable cancer coverage from physicians mutual, n.d.).

Premiums, copayments, and deductibles are not clearly defined because they are determined by the policy that the clients purchase. Eligible individuals must have a regular health insurance plan, not have previously been diagnosed with cancer, and not have conditions predisposing them to cancer. One must provide specific and detailed health history while applying for cancer insurance coverage to obtain a quote. While options for the clients to choose whether to receive benefits or their service providers is a significant advantage, unavailability of coverage in all states is a disadvantage.

MetLife

MetLife was founded in 1868 and operates in 40 markets worldwide. This firm provides cancer insurance policies through employer benefit programs. The insurance plan is portable, and payments are made directly to the clients to use them as they wish (Cancer Insurance, n.d.). Benefits associated with the coverage include annual cancer screening, treatments, cancer recurrence, hospitalization, initial diagnosis, and more.

The company does not mount premiums, copayments, and deductibles since they are determined by the policy that clients purchase. Eligibility and requirements are being an employee, having a regular health insurance plan, and not having been previously diagnosed with cancer. Advantages of this provider are that no physical is needed, coverage starts immediately, and the policy is portable (Cancer Insurance, n.d.). However, the policys availability only through employers is a major shortcoming for MetLife.

Differences Between Cancer Insurance and Health Insurance

Cancer insurance covers expenses related to the conditions treatments, the policy is benefit-based, and holders chose how to use payments. The insurance plan also covers clients against all stages of cancer and is ideal for individuals at risk for the disease. Further, people purchase it as a supplemental plan to a basic health insurance policy. On the other hand, health insurance covers a wide range of illnesses, and the insurer pays only hospital expenses. Unlike cancer insurance, a health insurance policy is for all individuals.

References

Aflac Supplemental Insurance. (n.d). Aflac. Web.

Cancer insurance. (n.d). MetLife. Web.

Cancer insurance | affordable cancer coverage from physicians mutual. (n.d). Physiciansmutual. Web.

Cancer treatment insurance. (n.d). Cigna. Web.

Hunt, J., & Figat, M. (2021). The 8 best cancer insurance providers of 2021. The Balance. Web.

The American Cancer Society. (n.d). Cancer facts & figures 2020/2021. Cancer. Web.

What is a cancer insurance policy? (n.d). healthinsurance. Web.

Cancer is the abnormal growth of cells, and it prevents other cells from obtaining nutrients. If a person is genetically predisposed to the disease, it can be difficult to avoid getting it. However, individuals could still minimize their risk by practicing certain behaviors. For instance, it is essential to adopt a physically active lifestyle, maintain proper nutrition, and avoid smoking. Additionally, it is advisable to always apply sunscreen regardless of whether a person is leaving the house or not. In case one develops cancer despite taking these preventative actions, there are various forms of treatment available. A patient may opt for one or a combination of the treatment options including surgery, chemotherapy, radiation, and immunotherapy (Liebman, 2019). Since people cannot always completely control their environment and lifestyles, understanding the causes, mechanism, and treatment of cancer is the first step towards combating the disease.

The sun can cause damage to the human skin including sunburns, aging, and cancer. Ultraviolet (UV) light is the main cause of skin cancer since it damages the genetic material found in skin cells. Although some UV rays are blocked by the ozone layer, it could still harm human beings. This is because humans have depleted the layer significantly over the years through activities such as use of chlorofluorocarbons. During the summer, people usually bask in the sun, possibly unaware of the damage they are doing to their skin. They should instead minimize their contact with the sun especially when it is extremely hot (Liebman, 2019). It is also prudent to apply sunscreen for protection against the harmful UV rays. Since the treatment options for this form of cancer are still under development, prevention is the best approach.

Reference

Liebman, B. (2019). How to lower your risk of cancer. Nutrition Action Health Letter, 46(3), 3-7.

Mrs. Wheeler is a 54-year-old woman suffering from colon cancer. She has undergone a surgery known as colostomy which involves opening the abdominal wall to get access to the colon. The patient requires particular care because the colostomy involves the removal of the colon from the human body to prevent the further spread of cancer. Therefore, the anus ceases to be the exit for human stool due to the disconnection of the anus from the intestines (Johns and Houlston, 2001). After the surgery, patients tend to pass soft stool because little water is absorbed depending on the size of the colon that remained after a colostomy.

Colon cancer is a disease that affects the colon in the human body. Cancer may affect the large intestines or the rectum and if not treated can be fatal. Glands in the lining of the colon develop polyps which are noncancerous but eventually develop into cancer. Cancer cells are dangerous because they glow exceptionally fast and overwhelm the healthy cell in the human body (Marchand et al., 2002). These polyps may result due to several factors, which include familial adenomatous polyposis or hereditary adenomatous polyposis which runs in family lines. This means that people whose families exhibit such polyposis remain at higher risk of developing the disease.

This disease may also be caused by a genetic abnormality whereby affected people may have a history of having tumors in other parts of their bodies. Colon cancer may be accelerated by the diets of individuals, obesity, cigarette smoking, and effects of drugs.

People with colon cancer may develop several complications and one should make sure that they visit their doctors for a checkup. This is vital because early detection of colon cancer may lead to its cure or prevention from further spreading. One of the symptoms is rectal bleeding which can be determined when one notices that their stool is mixed with blood. Rectal bleeding may lead to anemia if it is chronic and this result where goes unnoticed causing iron deficiency anemia (Johns and Houlston, 2001). Colon cancer can cause ones skin to be pale. It can also cause fatigue due to the little amount of water absorbed by the body caused by the infected colon inner walls. The tumor may enlarge blocking the colon and extending ones body, a condition known as abdominal distension. Finally, abdominal pain can be a symptom of colon cancer although the condition happens rarely.

Colon cancer can be prevented through health promotion activities. For example, by educating people on the most appropriate diets which are known to reduce risks of getting cancer. In addition, people should be educated on the dangers associated with cigarette smoking and eating unhealthy foods which lead to obesity. Finally, health workers should educate people on the importance of having checkups since early detection of colon cancer can lead to its cure (Lerman et al., 2002).

Cancer treatment involves the killing of the cancerous cell, but in the process, healthy cells get killed. Therefore, cancer patients need to observe diet since they have to replace health cells in their bodies. Diets for cancer patients depend on the stage of the infection, symptoms inhibited by patients, the type of cancer treatment, and its frequency. Cancer patients need diets aimed at helping them build the strength to fight the disease, help in withstanding cancer and its treatment and preserve lean body mass. Cancer patients are advised to take regular physical activities to keep them fit hence making their fight against cancer more effective. These include walking and other physical activities which do not require one to strain much.

Patients with colon cancer should concentrate on consuming foods rich in calories during treatment. Calories are noteworthy because they help patients to maintain their body weight during the treatment process. They should avoid consuming too much of one type of food because it can be harmful to their health. Nutritionists should help cancer patients to determine the right quality and quantities of food required by their bodies. Proteins are vital for a cancer patient, as well as it is crucial in maintaining the body strengths of the patient. This is necessary because sick people need to have the body strength to manage their sickness; otherwise, the disease cannot be fought.

Cancer patients need closely monitored diets to ensure that their health does not deteriorate. Patients who can eat should ensure that they increase nutrients in their diets by, for example, adding butter (Lerman et al., 2002). These nutrients are necessary for providing energy to patients hence making their bodies respond positively to the treatment. In addition, students with constipation complications should ensure that they take a lot of fluids, as well as foods rich in fiber. This is notable because constipation affects eating habits hence posing a danger to cancer patients. To avoid diarrhea in colon cancer patients, they should eat oranges, bananas, and potatoes and avoid eating foods rich in fiber. In addition, they should eat small amounts more often.

References

Johns, L. E. &Houlston, R. S. (2001). A systematic review and meta-analysis of familial colorectal cancer risk. American Journal of Gastroenterology, 96 (10), 29923003.

Lerman, C., Croyle, R. T., Tercyak, K. P. & Hamann, H. (2002). Genetic testing: psychological aspects and implications. Journal of Consulting and Clinical Psychology, 70(3), 784797.

Marchand, L. L., Donlon, T., Seifried, A., Kaaks, R., Rinaldi, S. & Wilkens, L. R. (2002). Association of a common polymorphism in the human GH1 gene with colorectal neoplasia. Journal of the National Cancer Institute, 94(6), 454460.

Guideline Developers

The National Comprehensive Cancer Network (NCCN) clinical guidelines are the recognized standard and most synoptic evidence-based practice (EBP) policies. One of the guidelines is the NCCN Guidelines for Patients with colon Cancer. The guideline was developed by a multidisciplinary panel comprising members of the NCCN institutions. The evidence is judged by experts in the medical field before the panel presentation and discussions commence. The NCCN special panel for guideline development is to get and scrutinize new evidence on cancer detection, risk reduction, prevention, workup, diagnosis, management, and supportive care (University library, 2022). The treatment recommendations the panelists provide are exact and integrated into practice through performance measurements.

Representation of Key Stakeholders

The guideline panel is representative as it includes oncology medical practitioners from reputable organizations and across all specialties. More than eighty different organizations are divided based on specialization, such as acute lymphoblastic leukemia, acute myeloid, and bone cancer, among others (Guidelines panels, 2022). Furthermore, the guideline update was done by a total of 61 panels comprising 1,700 oncology researchers and clinicians from 32 institutions registered by NCCN (About clinical practice guidelines, 2022). The selection of the panel is entirely based on merit and professionalism. Thus, there are no biases, and all stakeholders are represented.

Funding

The funding for the evidence-based guideline was primarily from the NCCN account. Notably, the organization relies solely on the grants and donations that it gets from the community. The NCCN foundation money is then allocated to different projects, including the continuous research and update of guidelines. Thus, the source of funding is ordinary people who care to give to enhance the treatment and prevention of cancer.

Status of Funding of Guideline Developers

Funding of individual researchers can create a conflict of interests because of the monetary investment. The NCCN guideline developers did not include a funded researcher of the reviewed studies (NCCN Guidelines, 2022). Oncology researchers from the NCCN institutions did all the reviewed studies. The money was used as part of the donations the community members gave to the NCCN account and then delegated for studies.

Development Strategy

The NCCN has a well-developed strategy used in selecting the panel and constructing the guidelines. First, the panel members are listed based on their specialties and institution. They then use flowcharts or algorithms to guide clinical decision-making (About clinical practice guidelines, 2022). Next is a discussion of clinical data and text describing the information that supports the recommendations. The following step is listing references and disclosing potential conflicts of interest to the NCCN headquarters staff or panel.

Explicit Decision Making

Arguably, the way decisions were made is sensible because the panel comprises many researchers and clinicians to minimize subjectivity. Moreover, each recommendation is backed-up by several references to studies that have been scrutinized for conflict of interests (About clinical practice guidelines, 2022). There was no impartiality in the identification, selection, and combination of the studies.

Literature Review

The studies included in the literature review were clinical trials with well-described methodologies. The implication is that they are reproducible as other interested researchers can replicate the study. Moreover, multiple studies are done for the same research question to confirm the findings. Moreover, the studies included in the development of the guideline are all recently published or revised within the past 12 months (About clinical practice guidelines, 2022). Therefore, the literature was comprehensive and combined several recent research studies with high credibility and validity.

Recommendations and Evidence

Each of the recommendations given is tagged by supporting the scientific clinical study. It is the norm for NCCN to ensure that all the recommendations they give are supported by research studies (About clinical practice guidelines, 2022). The strength of evidence is also considered such that meta-analysis is high in the hierarchy while expert opinions have low levels of strength. Moreover, the panel has to screen the studies to verify that it gives evidence for the recommendation.

Explicit Recommendations

The guideline provides explicit recommendations that reflect the value judgment on the result. For instance, there is a recommendation for colon cancer screening for all people for early identification of the disease (NCCN Guidelines for Patients, 2021). The recommendation for treatment is also different depending on the cancer stage. For instance, at stage one, no chemotherapy is done because it is not the most valuable solution at the point. Thus, there is a clear rationale for every suggestion in the guideline.

Peer Review and Testing

The panel members are expert researchers from the oncology department. They not only work by reviewing all the guidelines and discussing but also reviewing the final copy before the official publication (University library, 2022). Thus, the guideline is peer-reviewed and gets multiple updates from time to time as they receive new data that warrants a change in the guideline.

User Intent

All the NCCN guidelines are intended for national use because the studies are usually taken among the national representative sample. However, the NCCN is recognized as a reputable organization across many countries. Therefore, the guidelines are still internationally relevant for clinicians, oncologists, and cancer patients.

Clinical Relevance

The guideline is clinically relevant as it provides step-by-step recommendations for care options for cancer patients. It provides relevant information for the treatment and management of patients to improve their quality of life. In addition, it offers the best practices for clinicians, oncologists, and patients. Thus, following the guideline will likely minimize errors and ensure less hospital stay period.

Usefulness in Caring for Patients

The guideline is useful in caring for patients as it explains the different treatment recommendations for clients based on their stage of cancer. It also gives suggestions on the treatment planning process and the information that must be taken for diagnosis. For instance, the oncologist will need information including health history, colonoscopy, biopsy, imaging tests, biomarker testing, fertility, and family planning (NCCN Guidelines for Patients, 2021). The information is relevant in designing patient-centered care that is customized to suit the needs of the patient.

Practicality and Feasibility

The guideline is practical as it details what the patient and the clinician should do at each stage of the care continuum. For example, the guideline on taking patient history details the exact information that is needed. The guideline offers feasible suggestions that is useful in making a diagnosis.

Availability of Resources

The resources, including both people and technology, are available but limited. The increased prevalence of cancer creates a demand for oncologists, nurses, and other professionals working in the healthcare sector. The implication is that some hospitals may have a shortage of these staff. Similarly, the heavy machinery needed for chemotherapy is few, and patients must wait for their appointments by lining up.

Variation from Practice

The guideline recommendations are almost a replica of the standard practices. There are no significant variations because the information relies upon evidence from practice and select those that promises better outcome for the patients. Thus, clinicians are not asked to do anything outside the standard practice; every recommendation is backed by evidence from clinical trials.

Measurement of Outcome in Standard Care

The clinicians can measure the outcomes and make comparisons with the standard practice. For example, the quantitative assessment of the number of patients declared cancer-free after treatment following the guidelines. The reports and interviews are all possible measures to verify if there is an improvement in care.

References

About clinical practice guidelines. (2022). NCCN. Web.

Guidelines panels: Identification and disclosure of relationships with external entities. (2022). NCCN. Web.

NCCN Guidelines for Patients (2021). Colon cancer. Web.

NCCN Guidelines: Treatment by cancer type. (2022). NCCN. Web.

University library: Evidence based practice (NUR 4169): Practice guidelines. (2022). University Library at Florida Gulf Coast University. Web.

Prostate Cancer

Prostate cancer is the name given to the cancer that starts in the prostate gland. The prostate is a part of the mans reproductive system and is as big as a walnut. It is wrapped around the urethra, the urine carrying tube (Mason and Moffat 2003).The most common cancer to be diagnosed is that of prostate cancer (CaP). The malignant tumor is responsible for the cause of death of the majority of the American men. Overall prostate cancer is known to be the third commonest cause of death of men which have crossed the age of 75. Men less than 40 years of age are rarely found to have developed prostate cancer.

Those who have been found more vulnerable to this type of cancer are the African American men, men over the age of sixty and those that have history of prostate in the family. Those who take animal enriched fat diet, farmers, Painters, tire plant workers, alcoholics, men exposed to cadium and orange exposure are also at a greater risk of developing prostate cancer( Meyer and Nash 1994).

Most often the men with prostate cancer complain of the symptoms like leakage or dribbing of urine, blood in urine or semen, pain in the lower back and pelvic bones, delayed or slow urinary stream. For prostate screening the PSA (Prostate Specific Antigen) blood test is conducted. The diagnosis is confirmed the prostate biopsy. In this the tissue is taken from the prostate and is examined under the microscope. The results of the biopsy are based on the Gleason Grade and the Gleason Score. The Gleason grade is the determinant of the severity of the prostate cancer. The scale of the Gleason Grade is from 1-5.

This grading is done according to the shape of the cells. The more they differ from the normal cells the higher the grade value. Sometimes one tissue sample may have multiple Gleason grades. Hence for this purpose a Gleason score is created. In this the two most dominant grades of the tissue sample are added together using a scale of 2-10. The more higher the Gleason score the more it is probable that the cancer has spread beyond the prostate gland (Amin 2004). The cancer is graded as follows:

Score 2-4: Low grade cancer

Score 5-7: Intermediate grade cancer. It has been noted that the majority of the prostate cancer fall into this category.

Score 8-10: High grade cancer. The cells of this type of cancer are poorly differentiated.

Tests and Therapies available

The Prostate biopsy is needed when the PSA blood test is high. However even a rectal examination that shows a large prostate or hard irregular surface may also point to the prostate biopsy. PSA blood test is useful and done after the treatment of the cancer as well. For the spread of cancer CT scan and Bone Scan tests are performed (Mason and Moffat 2003).

The treatment for the prostate cancer depends and varies from person to person. The doctor usually advises the treatment according to the type of the cancer and the risks concerned with the patient. Usually a combination of 2-3 treatments is suggested.

Surgery is another option and is looked into after thorough discussion of the risks involved. This type of the surgery is called prostatectomy. Today it can be done with robotic surgery. The risks of the surgery are that patients often complain of uncontrolled urine, bowel movements and problems of errection.

Radiation Therapy

Other therapies include the radiation therapy and hormone therapy. In the radiation therapy powered x rays or radioactive seeds are used to kill the cancer cells. The radiation therapy is good when the doctor thinks that the cancer has not spread beyond the prostate gland and it is also useful in nullifying the pain when the cancer has reached the bone. The side effects of this type of therapy are bladder urgency, blood in urine, incontinence and impotency. Prostate brachytherapy is the name given to the treatment in which the radioactive seeds are placed inside the prostate to kill the cancer cells. The side effects of this treatment are swelling, bruising of the scrotum or penis, diarrhea, incontinence, red brown semen or urine and impotence.

Hormone Therapy

The hormone therapy is used mainly in patients in whom the cancer has spread. It is used to help alleviate the symptoms. Testosterone is the main hormone in the males. In case of prostate tumors the testosterone makes the cancer cells grow. So the hormonal therapy is provided to negate the effect of testosterone. The drugs that are used in the hormone therapy are two. These are the Luteinizing hormone releasing hormones (LH-RH) agonist and the androgen-blocking drugs (Masson and Moffat, 2003).

Drastic Treatments

More drastic treatments that can be used are the Orchiectomy which is the removal of the testes, as most of the testosterone is produced by them. Immunotherapy and chemotherapy is used when the cancer shows no effect after being treated by the hormone therapy. Single or combination of drugs is usually advised after the treatment. Routine checkups and PSA blood tests are recommended for a year.

Introduction to MICRO RNA

MICRO RNAs are found in all the eukaryotic cells and are considered to be the ancient part of the genetic regulation. They are short ribonucleic acid (RNAs) molecules. They have an average of 22 nucleotides and are post-transcriptional regulators that attach themselves to the complementary sequences on the target messenger RNA. This results in the gene silencing and translational repression.

Plants and metazoans, miRNAs, show entirely different characteristics. The plant miRNA complementarity to its mRNA is almost perfect. This is quite the opposite in the metazoans. There is also a difference of the location of the target sites on the mRNAs. The miRNA target sites of the metazoans are at the three prime untranslated regions. (3UTR) of the mRNA. In plants the targets are present at the coding regions as well as the 3UTR.

MiRNA are responsible for a lot of the developmental processes. They are thought to have some role in the gene expression and the fine tuning in the cells. Keeping in view of the targets of the miRNAS that might as well be thousands, they could be thought to be the formation of a layer of circulatory mechanism in the cell. By this it can be concluded that in case of mis regulation of these miRNAs the regulatory system of the cells could be affected as well. Hence the regulatory disruptions of the cell might be responsible for production of the tumors.

Characteristics of miRNA Action

There are many similarities of miRNA and the Transcription factors (TFs). Like them the miRNA has the ability to bind with the discrete cis-regulatory elements. Thereby they can control the targeted genes (Gaur and Ross 2009).Moreover miRNA use the binding site accessibility for the genes regulatory control. It jointly works to read out the combined expression patterns. The unique character of the miRNA is that they have the capability of spatially compartmentalization within a cell for the local alteration of the gene expression. They have more specified and pronounced regulatory control because of the speed and reversibility (Strooper Bart D and Christen Yves 2010, 104-129).

MiRNA and the non coding RNAs

The mapping of the first chromosome in 1999 revealed that human genome would probably consist of 100,000 protein coding genes. Yet the identification could only be made of some 20,000 proteins. After many studies it is revealed that majority of the transcripts are non coding RNA and also snoRNAs and miRNAs.

MiRNA and the nervous system

The miRNA have been found to be the regulators of the nervous system. These are the neural miRNA which function at the different stages of the synaptic development, synaptic maturation and formation. In patients with schizophrenia there have been found to be alteration of this miRNA.

MiRNA and heart disease

The involvement of the miRNA in the heart has been established by the inhibition of the miRNA maturation in the murine heart. It has been found that the expression levels of the diseased hearts have altered miRNAs (Appasani 2008).

MiRNA function in Cancer

Many types of the miRNAs have been linked with the cancer. According to a study conducted on mice which altered the production of c-Myc protein with multiple mutations It showed that miRNAs had an effect on the cancer. The mice died within two weeks of time that produced the miRNA in abundance. The mice without the surplus amount of miRNA lived twice as long. It is also now known that leukemia can occur with injecting the viral genome next to 17-92 array of the miRNAs. E2F1 is a protein that is responsible for the regulatory mechanism of the cell and already two types of the miRNA are found which inhibit the function of this protein. This occurs because of the miRNA binding to the messenger RNA before being translated to the proteins making them switch off and on (Wang 2009, 20-21).

Taking the measurement of the 217 genes that encode the miRNA, we can obtain the patterns of the gene activity and this knowledge will help in the evaluation of the different types of the cancer. Hence this signature of the miRNA will in future provide the knowledge for the classification of the different types of the cancer. Moreover with this in place the doctors would find it very easy to pinpoint the tissue which formed the cancer. With this the specific tissue targeting treatments could be achieved. Proven and in practice is already the profiling of the miRNA with which the doctors are able to identify the slow to fast progressive cancer in patients with chronic lymphocytic leukemia (Majumder 2009, 74).

MiRNA function in prostate cancer

MiR 17-92 has been found to suppress the working of the anti angi genic factors. There are many members of this cluster. One specific member of the cluster miR 17-92 is miR-20a is known for the oncogenic properties in the prostate cancer (Jain 2010).

Loss of p27 as the predictor for the recurring prostate cancer

The expression of p27 in the prostatectomy specimen is found to be in accordance to the biochemical recurrence. When this p27 is absent it clearly defines for the reoccurrence of the prostate cancer.

MiRNA Biomarkers of prostate cancer

A high throughput and optimized miRNA expression profiling provides exclusive identification from the prostate cancer biopsies. This enables for the differentiation of the pooled normal prostatic samples to those of the metastatic prostate cancers and non malignant precursor lesions (Jain 2010, 313).

Today the miRNAs expressions have been found to be a much authenticated diagnostic as well as prognostic tool for the prostate cancer. With the hierarchical samples of the prostate tumor in reference to their miRNAs expression it is now possible to separate and distinguish the benign prostate hypertrophy from the carcinomas. Further classification of the carcinomas is also possible for which the androgen dependence needs to be looked for.

Today in humans the serum levels of the miRNA can identify the person with prostate cancer to that of healthy person. Until now the some of the known different expressions of miRNAs that are related to the prostate cancer are the let 7-c,miR 19-b,miR20-a, miR29-b, miR-100, miR- 25b, miR-126*,miR- 128b, miR- 146a, miR- 146b, miR- 184, , miR- 221, miR-222, miR-361, miR- 424, miR- 663. However of these the specifications of only five are known.

Three of them have characteristics of oncogenes and two work as tumor suppressors. These are the miR- 20a, miR- 125b, miR-126*, miR- 146a and miR-221/222 respectively. The Oncogenic miRNAs are responsible for the down regulation of the apoptosis genes, whereas the tumor suppressors are taken as the new biomarkers. These are the future therapeutic targets for the prostate cancer treatment (Maulik Bandyopadhyay Wang 2010, 99-100).

It is the discovery of the miRNAs for the prostate cancer and the sites where they attach that has made possible the advancement in the cure of the disease. For the development of advanced and multiple therapies use of new computational methods is of inherent importance. Through direct biochemical cloning the miRNA genes are classified extensively. These are then gathered in the databases as miRBase and Micro RNA db.

References

Amin Mahul B. 2004. Gleason Grading of prostate cancer: a contemporary approach. Philadelphia: Lippincott Williams and Wilkins.

Appasani Krishnarao. 2008. Micro RNAs: from basic science to disease biology. United Kingdom: Cambridge University Press.

Gaur Rajesh k and Ross John J. 2009. Regulation of gene expression by small RNAs. USA: CRC Press.

Jain, kewal k. 2010. The handbook of biomarkers. USA: Springer.

Majumder Sadhan. 2009. Stem Cells and Cancer. USA: Springer.

Mason Malcolm and Moffat Leslie. 2003. Prostate Cancer: The Facts. New York: Oxford University Press.

Maulik, Ujjwal. Bandyopadhyay, Sanghamitra and Wang, Jason, T. 2010. Computational analysis and pattern analysis in Biology informatics. USA: John Wiley and sons.

Meyer Sylvan and Nash Seymour c. 1994. Prostate Cancer: Making Survival Decisions. USA: University of Chicago Press.

Strooper Bart D and Christen Yves. 2010. Macro Roles of Micro RNAs in the life and death of neurons. USA: Springer.

Wang Zhiguo. 2009. Micro RNA Interference Technology. USA: Springer.

Due to the explosion and fire at the Chernobyl Nuclear Power Plant, a huge quantity of radioactive iodine and caesium penetrated into the air. During the accident, emissions of iodine isotopes were noted, which pervaded into food, and then into the human body. The thyroid gland is extremely susceptible to the appearance of a dissolved isotope of iodine in the blood. The accident at the Chernobyl Nuclear Power Plant caused a threat to the health of people around the world, and only competent and timely actions made it possible to prevent an epidemic of thyroid cancer among American citizens.

To avoid the thyroid cancer disease epidemy, in order to reduce the effects of exposure to isotopes, the American population was recommended to take potassium iodine medication. In order not to miss the onset of the disease, citizens of America were required to undergo thyroid ultrasound once a year. Oncologists were engaged in the selection of the most effective drugs for the prevention. Nurses had to notify the American population, contributing to the informatization of patients regarding the necessary measures to stop this threat to health.

The chief doctors had to organize the smooth operation of ultrasound rooms and regulate the flow of patients in the hospitals. With the help of the implications that were produced, it was possible to reduce the predicted jump in thyroid cancer cases (Drozd et al., 2018). Fewer cases of thyroid cancer were detected immediately a few years after the accident than would have been the case without active prevention with iodine medications (Drozd et al., 2018). In addition, regular mandatory ultrasound made it possible to identify patients faster and improve treatment prognoses. Thus, the adopted healthcare strategies made it possible to successfully combat the spread of such a serious consequence of a man-made disaster as thyroid cancer.

Reference

Drozd, V. M., Branovan, I., Shiglik, N., Biko, J., & Reiners, C. (2018). Thyroid cancer induction: Nitrates as independent risk factors or risk modulators after radiation exposure, with a focus on the Chernobyl accident. European Thyroid Journal, 7(2), 67-74.