Knowledge Hub 02: Information and Education

Learning objectives

By the end of this Knowledge Hub, you will be able to:

1. Apply a person-centred approach in caring for people living with cancer.
2. Utilize the person-centred tool to elicit the perspectives of the person.
3. Identify how to accommodate learning preferences when educating people.
4. Integrate education principles into professional practice.
5. Discuss the fundamentals of cancer.
6. Explain the common types of cancer.

Introduction

In this knowledge hub, the principles of providing a person-centered approach will be discussed as this is vital to creating an individualized care plan for each patient. This approach can be used to involve the patient in their care and help respect the patient’s needs and values throughout their journey. The assessment tool helps understand the patient’s perspectives and further connects the healthcare team to the individual. Education and information during a cancer journey directly affect patients’ ability to make informed decisions about their care. We will also cover the adjustments to different learning needs and how to evaluate if the teaching has been successful (Picker, 2021; Biddy et al., 2015).

1. Apply a person-centred approach in caring for people living with cancer.

1.1 What is the complexity of cancer navigation in the healthcare system?

This PDF of BC Cancer’s website outlines the incredibly complex needs and approaches required to support cancer patients across the healthcare system. Specifically on Page 8, there is a Patient Complexity table that discusses: underlying medical co-morbidities, symptoms burden, nutrition needs, psychosocial/spiritual support, and patient engagement (BC Cancer, 2019).

Refer to Adult outpatient medical oncology services at http://www.bccancer.bc.ca/communities-oncology-network-site/Documents/Tiers%20of%20Service%20Outpatient%20Medical%20Oncology%20Services.pdf (BC Cancer, 2024).

1.2 What is a person-centered approach?

A person-centred approach “puts people at the heart of health and social services, including care, support, and enablement” (Picker, 2021). This approach encourages the recognition of people as individuals rather than patients and is actively involved in playing a pivotal part in their care (Picker, 2021). The use of this approach is aimed at health and support staff to understand and respect the needs and preferences of the person they are working with (Picker, 2021). Therapeutic relationships are vital to fostering a successful person-centred approach (Picker, 2021).

1.3 Apply a person-centered approach in caring for people living with cancer.

Cancer Care Ontario recommends multiple ways to endorse a person-centered approach for people who have cancer (Biddy et al., 2015). Some examples of applying this approach along someone’s cancer journey are knowing the patient as an individual, tailoring healthcare services for each patient, continuity of care and relationships and enabling patients to actively participate in their care (Biddy et al., 2015). This resource is available on Cancer Care Ontario website for additional insight into person-centered approaches in people who have cancer.

1.4 What is the focus of person-centered care?

The focus of person-centered care is to create a partnership between the person and healthcare professionals to give the patient more autonomy and involvement in their care (Biddy et al., 2015). Person centered care allows for people who have cancer to be an active participant in their care, maintaining patient and creating space for the person to have a voice in the care they receive and how they receive it, which also helps maintain patient engagement during their healthcare journey (Biddy et al., 2015). Overall, person-centered care focuses on curating the best health outcomes in a way that is individually tailored to the individual’s needs and ensures their wishes are respected at each stage with enough support to help them make informed decisions (Biddy et al., 2015).

1.5 What are the principles of person-centered care?

Person-centered care revolves around 8 principles:

1. Fast access to reliable healthcare advice: ease of appointments, minimal waiting periods for treatment, and appropriate availability of healthcare professionals (Picker, 2021).
2. Effective treatment by trusted professionals: positive therapeutic relationships, people need effective and appropriate care that aligns with their needs and preferences, so people should trust their care professionals (Picker, 2021).
3. Continuity of care and smooth transitions: all transitions between the range of care professionals should be seamless and fluid to provide coordinated care (Picker, 2021).
4. Involvement and support for family and carers: Care professionals must recognize the importance of families, caregivers, friends, and other loved ones in the person’s health and wellness (Picker, 2021). The involvement of these loved ones should be accepted and also supported during this time.
5. Clear information, communication, and support for self-care: healthcare services should be accessible, reliable, and of high quality at every stage in a person’s health journey (Picker, 2021). Information should be made readily accessible in a way that is understandable and supports the person’s decision-making process while managing their care (Picker, 2021).
6. Involvement in decisions and respect for preferences: people have the right to be aware of and involved in the decisions made about their health and healthcare professionals should be equal and respectful of persons choices regarding their health (Picker, 2021). Professionals should also take into account the person’s background, social and cultural values, and any other factors that may affect their decision-making capability (Picker, 2021).
7. Emotional support, empathy, and respect: this approach requires a holistic and caring approach that revolves around empathy, respect and addressing one’s emotional needs (Picker, 2021).
8. Attention to physical and environmental needs: people deserve to be cared for in a safe, private environment, that they feel comfortable in (Picker, 2021). Care professionals need to be aware of a person’s physical needs while caring for them (Picker, 2021).

2. Person-centred assessment to elicit the perspectives of the person.

2.1 Utilize the person-centred assessment to elicit the perspectives of the person.

The Feelings Ideas Functioning and Expectations (FIFE) tool was created to enhance the strength of the patient’s relationships with their healthcare team (Cancer Care Manitoba, 2021). It helps the healthcare team learn and understand the perspectives of the person during their healthcare journey.

F eelings:

• Do you have any specific fears or worries right now?
• What are you most concerned about?

I deas:

• What do you think might be going on?
• What do you think this pain means?

F unctioning:

• Do you have expectations about how your cancer team can help?
• What do you hope this treatment will do for you?

E xpectations:

• What goals have you had to give up because of your cancer?
• How does this cancer affect important people in your life?
  How has your cancer affected your day to day?

(Cancer Care Manitoba, 2021).

3. Identify how to accommodate learning preferences when educating people.

3.1 What are the diverse needs of people living with cancer?

All people living with cancer require different information during their cancer journey and their age can play a factor in what information they need (Rutten et al., 2003). Younger patients have access to a larger range of sources to seek out information from such as online sources (Rutten et al., 2003). While older patients turn more to their healthcare professionals for information regarding their cancer (Rutten et al., 2003). As well as this, multiple social factors can influence where patients get information and how they perceive this information. Factors such as education, access, and income can influence patient’s needs (Rutten et al., 2003).

3.2 What do patients want to know about cancer?

1. Cancer-specific information includes type of cancer, course of disease, physical effects, symptoms and symptom management and where to get information about specific cancer diagnosis (Rutten et al., 2003).
2. Treatment-related information includes available treatment options, side effects of treatments, benefits of treatment, treatment plan, alternative therapies, medications and clinical trials (Rutten et al., 2003).
3. Prognosis includes chance of cure, recurrence chance, spread of disease and effects on future life (Rutten et al., 2003).
4. Rehabilitation includes home care during recovery, nutrition, recovery time and where to get supplies (Rutten et al., 2003).
5. Surveillance includes maintaining physical health and prevention (Rutten et al., 2003).
6. Coping information includes emotional support, counselling community support and support groups (Rutten et al., 2003).
7. Interpersonal/social Information includes the effect on family/caregivers, risk of disease for family members and effect on work and social life (Rutten et al., 2003).
8. Financial/legal includes insurance coverage and advance directives (Rutten et al., 2003).

3.3 What are the benefits of meeting patient needs?

The benefits of identifying and meeting cancer patients’ information needs are to encourage patient involvement in decision-making and greater satisfaction with treatment choices (Rutten et al., 2003). As well as this, providing relevant information to clients during different times of need can lead to improved ability to cope with treatment, and diagnosis, and improve anxiety in patients (Rutten et al., 2003).

3.4 What are the sources of information for patients?

Some of the information for patients is through healthcare professionals (physicians, oncologists), media (internet, videos), printed material (books, magazines, news), interpersonal (peers, counselling) and scientific resources (telephone services, professional organizations, articles) (Rutten et al., 2003).

3.5 How to assess readiness to learn?

Readiness to learn is “defined as the time when the learner demonstrates an interest in learning the information necessary to maintain optimal health” (Kitchie, 2016). When assessing readiness to learn, the educator must recognize cues and information to determine if the patient is ready for education. A very important assessment of a learner’s readiness to learn is timing (Kitchie, 2016). Education must be completed when the learners are going to be receptive to the information that is provided. Anything that affects the psychological or physical comfort of a learner can impact their willingness to learn (Kitchie, 2016).

3.6 What are the factors that include a person’s readiness to learn?

P = Physical Readiness incorporates measures of ability, Complexity of task, Environmental effects, Health status and Gender.

E = Emotional Readiness includes anxiety level, Support system, Motivation, Risk-taking behaviour, Frame of mind and Developmental stage.

E = Experiential Readiness comprises a level of aspiration, Past coping mechanisms, Cultural background, Locus of control and Orientation.

K = Knowledge Readiness involves present knowledge base, Cognitive ability, Learning disabilities and Learning styles (Kitchie, 2016).

3.7 Describe the learning preferences of patients.

Diverging: Feeling and watching, watching rather than doing, using imagination to problem solve, and doing better in situations that require brainstorming ideas (Kitchie, 2016).

Assimilating: Watching and thinking, focuses on ideas and concepts, and requires clear explanations (Kitchie, 2016).

Converging: Doing and thinking, using learning to solve problems, preferring technical tasks and being less concerned with people (Kitchie, 2016).

Accommodating: Doing and feeling, very hands-on learners, prefer experimental approach (Kitchie, 2016).

4. Integrate education principles into professional practice.

4.1 What is the teach-back method?

The teach-back method is a learning method that involves asking the patient to confirm their understanding by stating in their own words what they were taught and allowing for any missing knowledge areas to be exposed (Agency for Healthcare Research and Quality [AHRQ], 2015). The teach-back method is a method created to ensure the patient understands what the healthcare member is teaching and that the teaching is effective (AHRQ, 2015). No matter the health literacy level of the patient or the nature of the information being given, it is important to ensure patients understand (AHRQ, 2015). This method allows for questions that might not have been covered otherwise and encourages improved patient understanding and improved patient outcomes (AHRQ, 2015).

Video 2.

See an example of this method in a healthcare setting in the video linked here. This shows a real-life example of a patient teaching session using this method to ensure accurate information was heard.

4.2 Illustrate a guide to use the teach-back method?

Try the teach-back method (AHRQ, 2015).

• Keep in mind this is not a test of the patient’s knowledge. It is a test of how well you explained the concept.
• Plan your approach. Think about how you will ask your patients to teach back the information. For example:
  • “We covered a lot today and I want to make sure that I explained things clearly. So let’s review what we discussed. Can you please describe the 3 things you agreed to do to help you control your diabetes?”
• “Chunk and Check.” Don’t wait until the end of the visit to initiate teach-back. Chunk out information into small segments and have your patient teach it back. Repeat several times during a visit.
• Clarify and check again. If teach-back uncovers a misunderstanding, explain things again using a different approach. Ask patients to teach-back again until they are able to correctly describe the information in their own words. If they parrot your words back to you, they may not have understood.
• Start slowly and use consistently. At first, you may want to try teach-back with the last patient of the day. Once you are comfortable with the technique, use teach-back with everyone, every time!
• Practice. It will take a little time, but once it is part of your routine, teach-back can be done without awkwardness and does not lengthen a visit.
• Use the show-me method. When prescribing new medicines or changing a dose, research shows that even when patients correctly say when and how much medicine they’ll take, many will make mistakes when asked to demonstrate the dose. You could say, for example:
  • “I’ve noticed that many people have trouble remembering how to take their blood thinner. Can you show me how you are going to take it?”
• Use handouts along with teach-back. Write down key information to help patients remember instructions at home. Point out important information by reviewing written materials to reinforce your patients’ understanding.

5. Basic fundamentals of cancer

Cancer can mean different things depending on who you are (BC Cancer, 2019a). You may think of something you read online, or what you have heard from another patient. In normal, healthy cells, the growth of new cells is closely supervised by the body. The normal process of control for growth is missing in cancer cells. Before cell growth becomes uncontrolled, there must be a series of mutations. Cancer can happen when carcinogens cause harm to the DNA within cells. This damage can then result in genes being changed, stopped altogether, or mutated. Gene mutations can also be caused by aging, having chemicals or radiation encounter your body, or by features of your body and the environment you are in. Carcinogens are not only in the environment you enter, known as exogenous carcinogens but also come from your body, known as endogenous carcinogens. There are different reasons cancers can happen, but it is mostly random for why it starts (BC Cancer, 2019a).

Several characteristics pertain to cancer cells (BC Cancer, 2019). Cancer cells can cause cell growth without any messages from the body. If the body tells the cancer cells to stop cell growth they do not follow these orders. The body uses apoptosis to control a cell’s life span, however, cancer cells evade this process and do not self-explode. Cancer cells can therefore live indefinitely, and even control the body’s supply of blood vessels to have a richer source of nutrients for tumour growth. Cancer cells can also spread from their original spot to a different one farther away in the body, also known as metastasis. Before metastasis occurs, the cancer needs to first invade tissues, develop a network of blood vessels, invade the lymph vessel, and then move on to different areas of the body (BC Cancer, 2019a).

Grading cancer is useful to know how much the cancer looks like a normal tissue. This helps healthcare professionals figure out what treatment plan will be needed, and what prognosis, or likely outcome will occur. The term differentiation refers to how well the cells look like healthy cells (BC Cancer, 2019a).

GX: means an assessment cannot be made

G1: The cells are well differentiated, resulting in a low-grade

G2: The differentiation is moderate, resulting in an intermediate grade

G3: The differentiation is poor, resulting in a high grade

G4: The cells are not differentiated, resulting in a high grade (BC Cancer, 2019a)

Staging is important to know if the cancer has spread from the original site to a different part of the body. Staging is dependent on the type of cancer, and is a complex process (BC Cancer, 2019a).

S0: The cancer is isolated to its starting place and has not spread.

S1-S3: The higher up the stage, the farther the cancer has spread, particularly looking to see if the cancer has moved to adjacent tissues or lymph nodes.

S4: This means the cancer has moved beyond the site of origin and is in other tissues further away, also meaning the cancer has metastasized (BC Cancer, 2019a).

Tumour – Node – Metastasis (TNM) is a method for describing the characteristics of cancer.

T or Tumour is looking at the overall size of the tumour, on a scale from T1 to T4

N or Node is looking to see if the cancer has entered the lymph node, either this has or has not occurred, represented by an absence or a positive “Nx”

M or Metastasis: refers to whether cancer has or has not spread to other tissues away from the original site, represented by an M0 and M1 (BC Cancer, 2019a).

A cancer that is larger and spreads through the body has a worse prognosis (BC Cancer, 2019a).

For males, prostate, colorectal and lung represent almost half of all cancers. For females, breast, lung and colorectal cancers form almost half of all cancers (BC Cancer, 2019a).

See Ferster, G. (n.d.). Verywell health. https://www.verywellhealth.com/know-your-breast-tumor-size-4114640

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Breast Cancer

The incidence in 2017 was about a quarter of all new cancer cases. Some risk factors for breast cancer include family history, the presence of certain genes, having had lobular carcinoma in situ before if there is atypical hyperplasia in a breast, and if over 75% of a breast’s volume is dense. It is common to treat breast cancer with radiation, systemic therapy and surgery (BC Cancer, 2019a).

Prostate Cancer

This cancer makes up 21% of all male cancers. 95% of all cases will be adenocarcinomas. Roughly 1 in 7 men will be diagnosed with prostate cancer. The risk factors for this cancer reflect certain ethnic heritage, if there is a family history, or if red meat and saturated fat are consumed in high amounts in a diet. The treatments reflect the risk level of developing this cancer. If the risk is low, then the medical system will monitor your health for any indications of this cancer. If there is an intermediate risk, then your health team will recommend surgery or radiation. If the risk is high, there will likely be use of androgen deprivation therapy, surgery or radiation used together or alone depending on the situation (BC Cancer, 2019a).

Colorectal Cancer

This cancer is number two on the list of total cancer diagnoses, with 13% of all cancers. It is a cancer that has a higher likelihood of death, for men, it is the second highest cancer causing death, and for women, it is the third. The risk factors for this cancer include a history of irritable bowel disorder, certain genetics, if there are polyps in the colon, if a person is not active, also known as sedentary, or if a person is overweight. The treatments for this cancer will be surgery, where a portion of the colon that is diseased is removed, or systemic therapy, which is reserved more for later stages of this disease, three and four (BC Cancer, 2019a).

Lung Cancer

For both men and women, this cancer is the second most common. It makes up roughly 14% of all cases of cancer. For the risk factors, smoking is linked to about 85-90% of all cases. Exposure to certain factors in the environment or at work, a history of this cancer in the family, or previously having lung cancer, are other risk factors. It is common to combine systemic therapy, chemotherapy and immunotherapy with surgery and radiation. Surgery mostly happens in the earlier stages, one and two. During the period of treatment, smoking cessation is desired (BC Cancer, 2019a).

Cancer Treatment

The goals of treatment are prevention, cure, control and palliative. Minimizing side effects and maximizing the death of cancer cells is always the guiding principle of treatment. Treatment options include surgery, systemic therapy, radiation therapy, clinical trials, and the benefits of smoking cessation (BC Cancer, 2019a).

Treatment Terms

You may encounter some terms linked to your treatment that do not make sense. These may include:

-Adjuvant: The healthcare team delivers your main treatment, then treatment after the main plan has been completed

-Neoadjuvant: This form of treatment comes before your main treatment plan is provided.

Dual Modality: This is when two different types of treatment are given at the same time. For example, receiving radiation and chemotherapy together.

Palliative: This treatment plan occurs when the goal is to manage the symptoms, control does not eliminate the cancer (BC Cancer, 2019a).

Surgery

Surgery may occur for several reasons that include obtaining a biopsy, or a sample of tissue, staging a tissue, preventing cancer from occurring, eliminating the presence or taking out part of cancer, and aiding the palliation of a person. It is very common to have experienced surgery, as the vast majority of people with cancer will have/will undergo surgery (BC Cancer, 2019a).

Radiation

In this type of treatment, x-rays or gamma rays, also known as photons, or particles, also known as protons, neutrons or electrons, are employed to treat cancer where it resides, also known as locally. These photons or particles work to stop the cancer cells by destroying the DNA in these cells. Radiation is useful as it can be targeted to a specific portion of a cell’s cycle. This form of therapy is more effective when the cancer cells have a higher degree of oxygen supply. Overall, 60% of all cancer treatment plans will have radiation as part of the plan. There are different ways to deliver the radiation. The external beam method works by sending X-rays from an external source into the body. These high-energy rays will vary on the exact type used based on the factors of the cancer. Another method, brachytherapy, involves the delivery of radiation “seeds” right into the tumour. This method has been known to cause fewer side effects, as cancer cells make up a greater amount of the cells being destroyed. The process of radiation therapy occurs in a controlled environment to ensure safety. Radiation occurs under a treatment plan given by a specialized healthcare team. If brachytherapy or Iodine 131 was part of a treatment plan, there are specific rules to follow to minimize the exposure that others around you receive (BC Cancer, 2019a).

Systemic Therapy

Systemic therapy means treatment that goes into the bloodstream to reach cancer cells (Alberta Health Services, n.d.b). There are several systemic therapies that you may have received:

Chemotherapy: Cancer cells are killed by drugs

Immunotherapy: Activation of your immune system to seek out cancer cells with the use of drugs

Hormone Therapy: Slowing or complete stoppage of cancer growth by using drugs to modify how hormones act in the body

Targeted Therapy: Cancer cells are prevented from growing and spreading by the use of drugs that target particular molecules (BC Cancer, 2019; BC Cancer, 2019a).

Chemotherapy

Is given throughout the body, so it can interact with all the body’s cells. It is designed to stop cancer cells from multiplying and destroying DNA in cancer cells. It can work on different parts of the cell replication cycle. Chemotherapy drugs can be given in many different manners, including intravenous (IV), or intramuscularly (IM). Often there are several different drugs given at the same time (BC Cancer, 2019a).

Immunotherapy

This type of therapy is designed to give a boost to the immune system so that the body can fight off cancer cells. This therapy is mostly given via IV. Sometimes immunotherapy drugs are combined (BC Cancer, 2019a).

Targeted Therapy

This therapy is known as a biotherapy because it can target specific elements of cancers, for instance, a protein, it acts as a disruptor in the pathways that cancer cells rely on to send signals, and it overall causes fewer side effects because normal cells receive less damage. The uses of this type of therapy include directly killing cancer cells, making cancer cells grow slower and focusing on the symptoms that cancer can cause to provide relief. This therapy is given either IV or via the mouth (oral) (BC Cancer, 2019a).

Hormone Therapy

Cancer cells need hormones to grow, so hormone therapy works by slowing how fast cancer cells can grow. This is done by giving more hormones, stopping the body from receiving a hormone or getting rid of hormones that are present. This therapy is given for specific cancers that respond to hormones, such as breast and prostate cancer. This therapy can be received orally or as an injection. This may be the only therapy or there may be other therapies used alongside (BC Cancer, 2019a).

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Clinical Trial

Cancer research provides new treatments and options, it is through clinical trials that these options can be delivered. The purpose of clinical trials is to have a greater understanding of cancer risk, be more efficient at cancer prevention and recognition, and have more effective treatments and cures (BC Cancer, 2019a).

Complementary and Alternative Medicine (CAM)

This is a broad group of health practices that are not included in the practices of conventional medicine. Examples include mind-based and energy practices. The benefits may include better quality of life, feeling better and better health overall. The risks of using these practices are that they may increase your side effects, can be the source of complications and get in the way of cancer treatment working effectively. If you decide you want to pursue CAM during your treatment it is best to share this information with your healthcare team, this way they can make informed decisions. Other examples of CAM include massage, Reiki, green tea, St. John’s Wort and probiotics. Natural products are recommended to be discontinued if the treatment includes chemotherapy, radiation or surgery (BC Cancer, 2019a).

Cannabis

Some of the symptoms related to cancer treatment include nausea, anorexia, pain, peripheral neuropathy, insomnia and anxiety. Some research finds these particular symptoms may be successfully treated by cannabis. THC and CBD are two of the cannabinoids that come from cannabis. THC is known to affect the mind, while CBD counters these effects. Both of these cannabinoids have healing properties (BC Cancer, 2019a).

Side Effects

Side effects happen when an unintended effect happens due to a treatment (Government of Canada, 2021).

Local Toxicities

Side effects that usually happen with radiation therapy, such as pain, skin reactions and hair loss (BC Cancer, 2019a). Care for side effects will be under the Resources tab, side effects section.

Systemic Side Effects

Some side effects affect many areas of the body. Receiving chemotherapy is a likely source of these side effects. Examples include fatigue, myelosuppression, fever, nausea and vomiting, diarrhea, alopecia and mucositis (BC Cancer, 2019a).

See SDI Productions. (n.d.). Moffitt Cancer Center. https://www.moffitt.org/cancers/cervical-cancer/faqs/how-do-i-manage-the-side-effects-of-cervical-cancer-treatment/

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6. Common Types of Cancers

Breast Cancer

Refer to the web pages, open press and education resources

D’Souza, M. S., Gidda, R., Wittal, D., & Dixon, D. (2023). Interdisciplinary approaches to psychosocial oncology . Breast Cancer Canada, Breast Cancer Society of Canada Grant. Canada.

D’Souza, M. S., Latif, E., & Edwards, A. (2022). Initiatives in Nurturing, Caring and Healing in Cancer Care . SSHR Exchange Knowledge Mobilization. Retrieved from

Research Grants

Educational Resources

D’Souza, M. S., Latif, E., & Edwards, A. (2022, January 02). Initiatives in Nurturing, Caring and Healing in Cancer Care . In WordPress: Thompson Rivers University.

Research Grants

Cancer Initiatives

Male Breast Cancer

Under 1% of all breast cancer diagnoses are found in men (Canadian Cancer Society, 2023a). Canadian Cancer Society (2023a) predicts that 270 men across Canada will be diagnosed with breast cancer, with 55 of these people dying. The American Society of Clinical Oncology (ASCO) (2022) explains that 84% of men with breast cancer will survive for 5 years. The percentage of men surviving breast cancer increases to 97% at the 5-year mark if the cancer is only located in the breast (ASCO, 2022). If the breast cancer was found to be in a regional node, the chances of surviving for 5 years is 83%. If the breast cancer spreads to a different part of the body the chances of surviving for 5 years is 22% (ASCO, 2022). Uscher (2022) explains that two reasons men can feel isolated are that many of the available services have been developed for women, and men may not know other men who have suffered from breast cancer. Although men have less breast tissue than women, they can still have breast cancer (Uscher, 2022). Men can find themselves with breast cancer that is more developed because they do not know they can have this type of cancer. Even though men with breast cancer may never have met another man with this type of cancer, it is important to reach out for help (Uscher, 2022). After Breast Cancer (2022) has shared Adam’s Story. For those that want to learn more about Adam, a man that had breast cancer when he was 31 years old, please use the resource for After Breast Cancer (2022).

Brain cancer

According to Brain Cancer Canada (2021), one third of the many different types of brain cancer are cancerous. Brain cancer is one of the leading cancers causing death for those under 40. Canadian Cancer Society (2023aa) shows that survival depends on the grade and type of the brain tumour. Specific statistics on brain tumours can be found through the link attached to the Canadian Cancer Society (2023aa) found in the Resources tab. A peer support program is offered by the Brain Tumour Foundation of Canada (BTFC) (2022c). At the link provided in the reference for BTFC (2022c), you can find out how to connect with a volunteer that has experienced a brain tumour. The presence of a tumour and treatment can cause you to have short-term memory loss (BTFC, 2022b). Some ways to manage this memory loss include writing information down, having a pen and paper near a telephone and using a calendar or daily planner. Other suggestions can be found in link for the BTFC (2022b) reference. Speak with your oncologist if you have trouble working, as you may need to stay on disability services. See if your place of employment can modify your work to accommodate your needs. Speak with your healthcare provider about your driving license, as it is common for this license to be suspended. You may be able to obtain your license again in the future. The Ministry of Transportation and your healthcare provider can answer any questions you have related to your ability to drive. If you have been advised not to drive by your healthcare team, please follow their recommendations. If you have children, your healthcare team must report this to the Children’s Aid Society if they feel they have a legal reason to do so. If you are seeking to travel, please seek out insurance. However, it may be difficult to obtain insurance with a known health issue (BTFC, 2022b). For more information, you can download the Brain Tumour Foundation of Canada App (BTFC, 2022a). Handbooks on a range of information for patients and caregivers can be found on the App. You can also order a hard copy of the handbooks and a children’s storybook on brain tumours at the link for the BTFC (2022d) reference. For information and resources on brain cancer survivorship, please visit the link in the ASCO (2021a) reference.

Colorectal cancer

Colorectal cancer ranks as the third most common cancer experienced by Canadians (Colorectal Cancer Canada, 2022b). This type of cancer can develop at a younger age and is currently being detected when it has progressed past the early stages. Colorectal Cancer Canada (2021) explains that remission happens when your cancer has gone away or lessened, yet there is still a chance the cancer may return. It is recommended to address any changes that may have happened due to your cancer. This includes building a plan for your health and attending follow-up meetings with your healthcare provider. Colorectal Cancer Canada (2021) says that cancer can come back, and you might expect to feel defeated at this time. However, you have been through cancer once, and you know what to expect. Just because the cancer has come back does not mean treatment will not work. The research on diet changes is mixed, but you can view this information at the link for Colorectal Cancer Canada (2021). To view discussions with people who have an interest in the progression of colorectal cancer care, please visit the link for Colorectal Cancer Canada (2022b) in the references. There are monthly support group meetings that take place on Zoom. The link for registration can be found in the reference for Colorectal Cancer Canada (2023a). There is a wide range of resources available, but not limited to, help for caregivers, help with fertility, financial support and how to care for an ostomy at the link in the Colorectal Cancer Canada (2022d). BC Cancer (2012) has provided a care plan for survivors of colorectal cancer. Please use this information alongside that of the wellness plan below and the advice of your care team. To learn about the perspective of a colorectal cancer survivor, please find the link in the reference for North York General (2017).

Prostate cancer

Worthington (2022a) explains that the definition of survivorship has changed to allow men to have better help. You may find that there are changes to how you think and behave that you may not notice. Yet, if you have a caregiver or family helping you, they might. For example, you may sleep more now and have a temper that does not tolerate much. Technology has changed, so if you would like a loved one to attend your meeting, but they cannot physically be there, it is possible to use Zoom or FaceTime for example, to help them be there with you. Worthington (2022b) says that sexual health is not talked about much, but it is an issue that can affect men. There are some solutions provided on the webpage that be accessed in the reference for Worthington (2022b). More information will discussed under the Side Effects portion of this package. Worthington (2022c) The Prostate Cancer Foundation (2022a) has a number of helpful guides on prostate cancer that be accessed in the Resources tab. Follow the link within the Canadian Cancer Society (2022b) to view helpful videos that explain topics such as what prostate cancer is, and what information about this type of cancer you should know. Advanced prostate cancer is also discussed by the Canadian Cancer Society (2023e) in one of the provided videos. The Canadian Cancer Society (2015) has put brochures that answer common questions about prostate cancer in English and French. Among these brochures are how to cope with prostate cancer, which explores side effects of having this type of cancer. If you access the link within the reference, Canadian Cancer Society (2023v), there is a large list of references about different cancers. If you scroll through the first page and onto the next pages, you will find there a lot of publications on prostate cancer. If you would prefer to have a copy of a publication, you can phone 1-888-939-3333, or email info@cancer.ca. There are a number of guidelines that healthcare professionals can use. If you are interested in reading on this subject, visit the American Cancer Society (2022) link in the Resources tab.

What is Androgen Deprivation Therapy (ADT)?

The Prostate Cancer Foundation (2022b) explains that testosterone is usually the focus of treatment when prostate is advanced or metastatic. Prostate cancer cells thrive on testosterone, so you may have been treated with a hormone therapy that suppresses this hormone. If you want to read further on specific side effects that are related to prostate cancer, Worthington (2022c) has provided a list of side effects, which can be accessed in the Resources tab.

Melanoma skin cancer

Melanoma can affect anybody, particularly those that are exposed to much to the sun, tanning beds and sunlamps (Melanoma Canada, 2022c). While the sky may appear cloudy or foggy, ultraviolet rays can still get through to you. According to the Canadian Skin Cancer Foundation (2018), the skin has cells that create the pigment that we see, and melanoma occurs in the cells responsible for this skin product. There are other forms of skin cancer including actinic keratosis and squamous cell carcinoma that are presented by the Canadian Skin Cancer Foundation (2018). Using the link for the Canadian Skin Cancer Foundation (2018) you may find descriptions of skin cancers, how to identify them, where they commonly occur, and how they develop. There are several tabs on the Canadian Skin Cancer Foundation (2018) webpage that help with prevention of skin cancer, how to stay safe while being outside in the sun, and support for patients. Under the tab for support, there are links to other organizations that conduct work related to melanoma cancer. The link to the Canadian Dermatology Association (2023) has a quick webinar that can help answer a variety of questions about melanoma. The link to the Save Your Skin Foundation (n.d.) provides information about forms of treatment and various resources for patients and caregivers. There are support groups, webinars and help understanding what life after cancer may look like. Melanoma Canada (2022c) has videos and survivors have shared their stories. You can visit virtual support groups offered by Melanoma Canada with the link for Melanoma Canada (2022c). Melanoma Canada (2022a) describes helpful activities to aid your health. There are some side effects of melanoma discussed, with some solutions provided. We will be discussing side effects and solutions for management further on in this guide. There are different guides, both healthcare professional and patient styles, available in the Melanoma Canada (2022b) reference.

Lung cancer

Lung Cancer Canada (n.d.) knows that there are many different questions that you may have about your diagnosis, treatment and what happens next. Under the resources tab is a phone number and an email that patients and caregivers are encouraged to access. The lung cancer tab has a variety of links for forms of treatment, the staging and screening process, and what activities help somebody carry on with life with lung cancer. Under the resource tab there is also a page for stories of survivors. Here you may see what other people’s experiences have been with lung cancer. Under the get involved page you can find ways to connect with a Registered Social Worker for support. You can arrange to meet over the phone or the Zoom platform. You can also set up meetings with peers that act as a navigator/mentor to help guide you through the process of living with cancer. The Canadian Lung Association (n.d.) presents topics that affect overall lung health, such as vaping and smoking. Under the lung health tab, there is an alphabetical list of lung conditions that can be visited. If an inhaler has been prescribed to you by your healthcare provider, there is a tab that provides more information on how to use this device properly. Depending on the type of treatment you have received, you may feel tired, have trouble breathing and chronic pain (Rajapakse,2021). Smoking is not the only reason that lung cancer develops. You may feel that society is judging you about your diagnosis. Rajapakse (2021) explains that you may start to feel anxious or feel isolated from those around you due to the stigma that society carries towards lung cancer. Those that live in a rural setting could have a worse experience, as rural communities can lack access to mental health support, and have reduced resources to help with socioeconomic challenges. Those that belong to a racial and ethnic minority, have less education, and are ranked as having a reduced socioeconomic status have a higher likelihood of experiencing poorer outcomes. Chemotherapy can cause challenges with the brain, also known as cognitive impairment, but these issues usually go away by the seventh month. Rajapakse (2021) explains that being concerned about sexual health is a topic that many cancer survivors have, and these challenges can cause distress. It is fairly common for some cancer survivors to resume smoking after treatment. This may be related to a reduced amount of support and the amount of cigarettes smoked per day.

See National Academy of Medicine. (n.d.). https://www.nam.edu/moving-research-into-practice-physical-activity-nutrition-and-weight-management-for-cancer-patients-and-survivors/

See Stanford Medicine. (n.d.). https://www.med.stanford.edu/aftercancer.html

Summary

Over this hub, we have discussed how a person-centered approach can be used to support caring for those with cancer. By using this approach, we can encourage continuity of care and enable patients to participate in their care by understanding their specific needs and information needed to make decisions (Biddy et al., 2015). The FIFE tool is an additional resource that can be utilized. This tool from Cancer Care Manitoba is used to strengthen the relationships between the patients and their healthcare team. By considering a patient: feelings, ideas, functioning, and expectations we can work to understand a patient during their healthcare journey (Cancer Care Manitoba, 2021). Throughout this hub it is recognized there are many diverse needs of patients and that information required can vary among everyone. Information across topics such as cancer-specific information, treatment-related information, prognosis information, rehabilitation, etc. can have different needs at each phase of cancer (Rutten et al., 2003). Before teaching patients information about these topics, it is necessary to assess a patient’s readiness to learn to determine if this is the right time to teach. Physical readiness, emotional readiness, experiential readiness, and knowledge readiness are all areas that determine a readiness to learn. As well as this the learning preference of patients’ needs to be discussed to discover the best ways to engage the patients and have the most effective teaching. The teach-back method is a guide to assess the patient’s understanding by having them repeat in their own words what they were taught (Kitchie, 2016; Allina Health, 2013).

References

1. Agency for Healthcare Research and Quality [AHRQ]. (2015). Use the teach-back method. AHRQ Health Literacy Universal Precautions Toolkit Second Edition .
2. BC Cancer. (2019). Tiers of Service: Adult Outpatient Medical Oncology Services. BC Cancer.
3. Biddy, R., C. G., N. Johnson, G. Larocque, H. Messersmith, L. Moody, H. Shamji, C. Stevens, C. Zwaal, S. Singh, Person-Centred Care Guideline Expert Panel. (2015). Cancer Care Ontario: Person-Centred Care Guideline.
4. Cancer Care Manitoba. (2021). Advance Care Planning with Your Patients.
5. Graydon, J., Galloway, S., Palmer-Wickham, S., Harrison, D., Rich-van der Bij, L., West, P., . . . Evans-Boyden, B. (1997). Information needs of women during early treatment for breast cancer. J Adv Nurs, 26 (1), 59-64. doi:10.1046/j.1365-2648.1997.1997026059.x
6. Howell, D., & Olsen, K. (2011). Distress-the 6th vital sign. Curr Oncol, 18 (5), 208-210. doi:10.3747/co.v18i5.790
7. Kitchie, S. (2016). Determinants of Learning. Retrieved from

   Determinants of Learning

8. McLeod, S. (2017). Kolb’s Learning Styles and Experiential Learning Cycle. Retrieved from

   Kolb’s Learning Styles and Experiential Learning Cycle

9. Picker. (2021). Principles of Person Centred Care. Retrieved from https://www.picker.org/about-us/picker-principles-of-person-centred-care/
10. Rutten, L. J., Arora, N. K., Bakos, A. D., Aziz, N., & Rowland, J. (2005). Information needs and sources of information among cancer patients: a systematic review of research (1980-2003). Patient Educ Couns, 57 (3), 250-261. doi:10.1016/j.pec.2004.06.006

Resources

BC Cancer. (2024, April). Adult outpatient medical oncology services. Provincial Health Services Authority, BC Cancer, British Columbia.

http://www.bccancer.bc.ca/communities-oncology-network-site/Documents/Tiers%20of%20Service%20Outpatient%20Medical%20Oncology%20Services.pdf

Videos

Allina Health. (2013, Dec 24). The Teach-back Method. [Video]. Youtube. https://www.youtube.com/watch?v=pCNCqA5LqFo

World Health Organization. (WHO). (2017, June 21). WHO: What is people-centered care? [Video]. Youtube. https://www.youtube.com/watch?v=pj-AvTOdk2Q

Images

Alex Promios. (2012). [The Stethoscope]. Flickr. https://flic.kr/p/bt29wL.

Alex Promios. (2012). [ And you havent been to your Doctor because?]. Flickr. https://flic.kr/p/bt67c1 ).