Knowledge Hub 03: Assessment and Strategies
Learning Objectives
By the end of this Knowledge Hub, you will be able to:
- Recognize the importance of using consistent approaches in symptom screening.
- Use scientifically recognized tools to screen patients living with cancer for symptoms.
- Learn how to utilize symptom assessment tools such as BC cancer symptom management guidelines and other resources.
Introduction
Cancer can cause a wide range of physical and psychological symptoms that can affect the quality of life in patients, and it is essential to monitor to increase health outcomes and patient satisfaction. In this hub, we will cover the importance of screening patients for symptoms, and which standardized tools are recommended for the most successful understanding of the patient’s current symptoms. Screening and various assessments will be discussed for optimal communication between the healthcare team and the patient (Cancer Journey Action Group
[CJAJ], 2009).
1. Recognize the importance of using consistent approaches in symptom screening.
1.1 What are the goals of cancer screening?
The goal of cancer screening for patients is to work with them to understand the physical, psychological, and other concerns affecting their lives (CJAG, 2009). By recognizing these symptoms, the healthcare team can work to prioritize interventions to help patients along their cancer journey (CJAG, 2009). This can help improve the treatment of symptoms, improve collaboration within the healthcare team and with the patient, and also promote a patient-centered approach to engage the patient in their care journey (CJAG, 2009).
Refer to EPICC – The early symptom indicators for cancer care screening program at http://www.bccancer.bc.ca/our-services/centres-clinics/bc-cancer-vancouver/epicc (BC Cancer, 2024).
Refer to cancer screening at http://www.bccancer.bc.ca/health-info/screening (BC Cancer, 2024).
1.2 What are the reported outcomes?
Patient-Reported Outcomes (PROs): Provide a comprehensive and in-depth understanding of the impact cancer and cancer treatment have inflicted on the patient, from the patient’s perspective (Canadian Partnership Against Cancer [CPAC], 2015). PROs help the healthcare team gain a deeper understanding and allow them to focus on the physical and psychosocial concerns and accurately adjust a healthcare plan for each person (CPAC, 2015). Certain tools were created to question PROs that patients can complete, allowing for prioritizing and tracking of certain symptoms during someone’s journey (CPAC, 2015). Goals of PRO’s: early identification and treatment of symptoms, improved interdisciplinary teamwork, and actively engaging the patient in their care (CPAC, 2015).
Refer to measuring patient experience at http://www.bccancer.bc.ca/about/accountability/patient-family-experience/measuring-patient-experience (BC Cancer, 2024).
Refer to our cancer statistics at http://www.bccancer.bc.ca/health-info/disease-system-statistics/our-cancer-statistics (BC Cancer, 2024)
1.3 What are the common concerns of patients living with cancer?
As previously covered in Hub 1, the needs of patients needs vary among each other and their stage in their cancer journey. Listed below are some of the common concerns.
- Physical: The maintenance of physical comfort, pain, control, nutrition, and ability to engage in normal daily activities (Fitch, 2008). Examples are pain, weakness, fatigue, anorexia, nausea & vomiting, mobility and lymphedema.
- Emotional: A sense of comfort, belonging, acceptance and encouragement during stress (Fitch, 2008). Examples are fear, anxiety, depression, guilt, anger, powerlessness, isolation and sexuality concerns.
- Practical: Assistance related to tasks or activities that have to be carried out in everyday life (Fitch, 2008). Examples are shopping, transportation, childcare, family relief, family stresses, financial issues, legal issues and home care activities.
2. Use scientifically recognized tools to screen patients living with cancer for symptoms.
2.1 What are standardized cancer screening tools?
Standardized cancer screening tools can vary in focus, and type of questionnaire but must maintain these principles to be deemed suitable screening tools per the Screening for Distress Toolkit includes screening for psychosocial, practical, and physical domains of needs, must be reliable and valid (psychometric properties) and has a minimum required data set when screening for symptoms? (CJAG, 2009).
2.2 Illustrate the Edmonton Symptom Assessment System – revised (ESAS-r).
The Edmonton Symptom Assessment System (ESAS-r) screening tool is a very common screening tool used in Canada (CJAG, 2009). It screens for nine different common symptoms related to cancer on a numerical scale from 0-10 (CJAG, 2009). This tool can be used for patients in the early or later stages of a cancer journey and can be tracked to evaluate for effectiveness in symptom management (CJAG, 2009). The tool screens for shortness of breath, pain, tiredness, nausea, anxiety, drowsiness, appetite, well-being and depression (CJAG, 2009).
2.3 Demonstrate the Canadian Problem Checklist (CPC).
The Canadian Problem Checklist (CPC) asks questions to screen the most common emotional, practical, and physical concerns for cancer patients (CJAG, 2009). This tool is used with the ESAS-r to cover concerns not screened for in the ESAS-R (CJAG, 2009). Patients can use the checkboxes to tick off concerns that have been prevalent for them within the past week (CJAG, 2009). The CPC screens for issues across the domains of needs such as emotional, physical, social, spiritual, practical, and information problems (CJAG, 2009).
ESAS-r and CPC (Page 70, Appendix B)
2.4 Give examples of self-administered cancer screening tools in Canada for patients.
The ESAS-r and CPC are both examples of self-administered screening tools offered to patients to gain perspective on the effect cancer symptoms are having on their lives.
Exhibit the screening tool Putting Patients First (PPF) .
The PPF screening tool questions the patient about how they feel since their last visit with the healthcare team and how they feel today. (CJAG,2009). This tool covers physical symptoms on a numerical scale of 0-10, concerns and fears regarding emotional, social, practical, mobility, physical, nutrition, and informational issues, and briefly questions if medications have changed or other parts of the healthcare plan have changed in between visits (CJAG, 2009).
Explain the Comprehensive Problem and Symptom Screening (COMPASS) .
The COMPASS screening tool from Cancer Care Manitoba uses the ESAS-r and CPC tools and an advanced care planning section (with the option to not answer if uncomfortable) (Cancer Care Manitoba, 2021).
COMPASS Screening Tool
Refer to symptom management at http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management (BC Cancer, 2024).
2.5 How to assess the self-image and sexuality of patients living with cancer?
Refer to sexual health at http://www.bccancer.bc.ca/health-info/coping-with-cancer/managing-symptoms-side-effects/sexual-health (BC Cancer, 2024)
Cancer can affect a person’s libido, body image, sexual function, and possible sex organs (American Cancer Society, 2020). Sexual problems can arise with side effects, both physical and psychological, of cancer and cancer treatments (American Cancer Society, 2020). Treatment can cause nausea, pain, bowel problems, chronic fatigue, and changes in appearance (IE: loss of hair) (American Cancer Society, 2020). These effects can lead to feelings of poor self-image and possibly an inability to be intimate which can lead to a decreased desire to be intimate. This conversation may be uncomfortable for patients to engage in with their healthcare team, but it is important to assess and normalize this conversation (American Cancer Society, 2020).
2.6 Give examples of questions to ask during the assessment.
It is important to ensure the patient consents to and is comfortable talking about sexuality and intimacy before engaging in assessment questions. During assessments, be aware patients may have boundaries and may not feel comfortable discussing all aspects of the assessment. Keeping this in mind, allow the patient to decide how much they share about their sexuality.
- Do you feel that your diagnosis has led to a change in your sexual feelings, if so in what ways?
- What do you believe is causing your difficulties?
- Are their physical symptoms limiting your ability to be intimate?
- What are your goals for intimacy and sexuality?
- How has treatment affected your relationship with your partner?
- Can you describe your concerns regarding sexuality and intimacy?
(BC Cancer, 2018).
Intimacy and Sexuality Assessment Guide
Provide resources for patients regarding self-image and sexuality.
3. Learn how to utilize symptom assessment tools such as BC cancer symptom management guidelines and other resources.
3.1 How to perform a multiple symptom assessment?
After completing the self-administered screening tools (ESAS-r and CPC), the healthcare team must discuss the severity of the symptoms and how this affects the patient’s life (CJAG, 2009). By assessing multiple symptoms of cancer, the team can work together with the patient to address interventions and prioritize symptom management (CJAG, 2009).
Refer to symptom management at http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management (BC Cancer, 2024).
Refer to the symptom management and side effect management resource guide at http://www.bccancer.bc.ca/health-professionals/clinical-resources/pharmacy/symptom-side-effect-management-resource-guide (BC Cancer, 2024).
3.2 How to perform a pain assessment?
- Normal : Is this a pre-existing or new pain?
- Onset : When did the pain begin? How long does it last? How often does it occur?
- Provoking : What brings it on? What makes it better or worse?
- Quality : What is your pain like at rest? How would you describe it? (burning, stabbing, shooting, numbing)
- Radiation : Where is the pain? Does it spread?
- Severity : What is your pain on a scale of 0-10? Does the pain keep you awake at night or affect your ADL performance?
- Treatment : What medications or treatments have you been using to treat the pain? Has this been effective? (BC Cancer, 2018).
Refer to pain and symptom management at http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/supportive-care/pain-symptom-management (BC Cancer, 2024).
3.3 How to perform a psychosocial and spiritual assessment?
The FICA spiritual tool helps healthcare professionals assess a patient’s connection to their spirituality and their preferences regarding this (GWish, 2021).
F. Faith, Belief, Meaning : Determine whether or not the patient identifies with a particular belief system or spirituality at all. “Do you consider yourself to be spiritual?” or “Is spirituality something important to you?”
I. Importance and Influence: Understand the importance of spirituality in the patient’s life and its influence on healthcare decisions. “What importance does spirituality have in your life?” or “Has your spirituality influenced how you take care of yourself, particularly regarding your health?”
C. Community: Find out if the patient is part of a spiritual community, or if they rely on their community for support. “Do you consider yourself to be a part of a spiritual community?” or “Is your community a support system or network to you and how?”
A. Address/Action in Care : Learn how to address spiritual issues concerning caring for the patient. “How would you like me, as your healthcare provider, to address spiritual issues in your healthcare?
3.4 How to perform a risk assessment?
The Breast Cancer Risk Assessment Tool is used by healthcare professionals to determine the level of risk of a woman developing breast cancer. The online assessment tool covers patient eligibility, demographics, and patient and family history. This tool has some limitations and cannot accurately estimate breast cancer risks for certain situations (National Cancer Institute, 2019).
Refer to risk factors at http://www.bccancer.bc.ca/screening/breast/breast-health/risk-factors (BC Cancer, 2024).
Refer to high-risk clinic http://www.bccancer.bc.ca/our-services/services/hereditary-cancer/high-risk-clinic (BC Cancer, 2024).
3.5 How to conduct a telephone screening and motivational interview?
Telephone screening has been utilized for screening programs for cancer patients as an alternative option to coming into an office or hospital. Healthcare professionals may require additional training and teaching to be competent in assessing symptoms over the phone. The Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) group has created a guideline for providing support and assessments over the telephone (Ottawa Hospital Research Institute, 2020). The guideline covers 17 different assessment tools for different symptoms and can help healthcare professionals provide a comprehensive and complete assessment (Ottawa Hospital Research Institute, 2020).
Each symptom guideline follows the same five principles:
- Assess symptom severity.
- Triage patient for symptom management
- Review medications being used for symptoms.
- Review self-care interventions (using motivational interviewing)
- Summarize the assessment and plan agreed with the patient.
(Ottawa Hospital Research Institute, 2020).
Symptom Triage and Remote Support Tool
3.6 How to conduct a motivational interview?
Motivational interviewing is a style of communication that is patient-focused and collaborative to strengthen the patient’s motivation to change and become involved in their care (UBC CPD, 2022). Motivational interviewing uses reflective listening and “change talk” (the encouragement for a patient’s urge and motivation to make change) (University of Victoria, 2020). Motivational interviewing is a learned skill that requires careful training to honour the patient’s autonomy rather than providing them with solutions (University of Victoria, 2020). The University of British Columbia offers a free, self-paced eLearning course, which covers key strategies and tools that make up Motivational interviews, how to approach behavioural change in clinical practice through Motivational interviews, and resources to support growth and Motivational interview Development (UBC CPD, 2022).
Link to free UBC CPD MI Course
3.7 Explain the interventions to manage symptoms, side effects and well-being using the BC Cancer guidelines.
The BC Cancer Guideline for Symptom and Side Effect Management links multiple resources from varying credible resources for healthcare professionals to help patients address their symptoms. Examples of some side effects covered in the Guideline are anemia, anxiety, diarrhea, fatigue, headache, hair loss, nausea and vomiting, vaginal dryness and weight gain (BC Cancer, 2023).
Refer to symptom management at http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management (BC Cancer, 2024).
3.8 Side-effects of cancer treatment
Refer to the following web pages and 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
Skin problems
Cancer treatment can cause the skin to become dry, flaky or develop a rash (Canadian Cancer Society, 2023v). Skin may become swollen, nails may change their appearance, becoming dark or yellow. There are other skin issues, as well as ways to manage these symptoms, which can be accessed via the link in the Canadian Cancer Society (2023x) Resources tab.
Skin problems | Canadian Cancer Society
Dysphagia
Dysphagia occurs when it becomes difficult to swallow (BC Cancer, 2023i). Signs of dysphagia include mealtimes taking longer to complete, coughing upon swallowing and feeling as if food has become lodged in the throat. This condition can be caused by a tumour or the effects of cancer treatment. Find more information that describes how to assess for dysphagia in the Resources tab
Swallowing Difficulties (Dysphagia) (bccancer.bc.ca)
Alopecia
Also known as hair loss, alopecia can occur with cancer treatment (Canadian Cancer Society, 2019). The degree of hair loss depends on what and how the cancer drugs were used to treat your cancer. Different forms of cancer treatment, such as radiation, may not act the same as chemotherapy. It is recommended that a wig or hairpiece be selected before hair loss occurs in order to best match your hair colour. More information on the effects of different treatments on hair loss, prevention and treatment options, can be found by accessing the link in the Resources tab.
For information on where to access wig services, please see the Resources tab.
Hair loss | Canadian Cancer Society
Fatigue
It is common to experience fatigue during cancer treatment (Canadian Cancer Society, 2023m). Fatigue means feelings of tiredness, exhaustion or having no energy. This is not the same thing as feeling tired after a long day. Fatigue is important to address because coping can become more difficult. For a complete list of symptoms of fatigue and how to treat fatigue, visit the link in the Resources tab
Fatigue | Canadian Cancer Society
Nausea/Vomiting
Cancer Care Ontario (2019) explains that nausea and vomiting can be assessed for different characteristics, to understand how severe the nausea is. There are different ways that these conditions can be treated, using ways that do not involve medications, or careful changes to drugs. More information can be found in the Resource tab then selecting “Algorithm.”
Nausea and Vomiting | Cancer Care Ontario
Diarrhea
Cancer Care Ontario (n.d.a) explains that treatment and medications can cause diarrhea. It is a common condition resulting from chemotherapy, radiation and immunotherapy. Many different forms of treatment can be found using the Cancer Care Ontario (n.d.a) reference link, and then clicking on “Algorithm.” Other information you may find helpful can be found by clicking on the “Patient Guide” link found in the Resources tab.
For further information see Diarrhea | Cancer Care Ontario
Muscle Aches
Also called myalgia, muscle aches can range from mild to severe, that may also be present or sometimes disappear. Muscle aches can be due to tumours or treatments for cancer, or they may be unrelated to your cancer and be caused by things such as hormones or the chemistry of the blood. It is best to ask your healthcare team about myalgia. The Resources tab can provide you with more information on treatment options.
Fertility
The Canadian Cancer Society (2020a) recognizes that problems with fertility can occur because of cancer treatment. These issues are not always permanent, but sometimes they are. It is best to ask your healthcare team about possible solutions before treatment has started. However, if treatment has begun or has completed, still reach out to find out what options may exist. There are many different causes, possible fertility preservation options, and options to become a parent that can be explored using the Resources tab.
Fertility problems | Canadian Cancer Society
Cystitis
Weaver (2022) explains that cystitis occurs when the lining of the bladder has become irritated. It can become irritated enough where bleeding occurs, which can result in infection. A treatment does not exist to stop this side effect, which may lead your healthcare team to decide to stop your current form of cancer treatment. Some of the signs that may indicate the presence of cystitis include pain in your abdomen, pain when urinating and blood in the urine. There are prevention measures that may help, which can be viewed using the Resources tab.
Bladder Side Effects of Cancer Treatment – CancerConnect
Pulmonary Fibrosis
Pulmonary fibrosis is a condition where the lungs become thickened with scar tissue, which can be due to cancer treatment (Cleveland Clinic, 2021). This results in it becoming harder for a person to breathe because the lungs cannot expand like they used to. It will worsen over time and currently leads to an irreversible death. Its symptoms include shortness of breath, shallow breathing and a dry cough. The Canadian Pulmonary Fibrosis Foundation (n.d.) has a variety of resources and information for further understanding this disease. These can be accessed by using the Resources tab.
Canadian Pulmonary Fibrosis Foundation What is Pulmonary Fibrosis (cpff.ca)
Pulmonary Fibrosis: What is It, Causes, Symptoms, Testing & Treatment (clevelandclinic.org)
Cardiotoxicity
Cardiotoxicity is referred to as heart problems that occur because of cancer treatment (Ted Rogers Centre For Heart Research, 2022). Some of the symptoms that may be experienced include edema/swelling in the legs, feeling tired from regular exercise and shortness of breath. Along with cancer treatment killing cancer cells, healthy cells are also affected. Monitoring for the symptoms and incorporating healthy lifestyle changes can help minimize the risk for cardiotoxicity. For other suggestions visit the Resources tab.
Cancer and the Heart – Ted Rogers Centre for Heart Research (tedrogersresearch.ca)
Local Reaction
Radiation can cause the skin in the area of treatment to become reddened (BC Cancer, 2019a). There may be diarrhea, pain or hair loss too. Cancer Care Manitoba (2010) has more information on the specifics of radiation, and recommends talking with your healthcare team if you experience side effects. More information can be found in the link for Cancer Care Manitoba (2010). The Resources tab has information on side effects and management.
Radiation_Facts-English.pdf (cancercare.mb.ca)
Renal Failure
Renal failure is one of the ways the kidney can be affected by cancer treatment (Canadian Cancer Society, 2023o). Some of the symptoms that may be experienced include high blood pressure, changes in a normal urination pattern, swelling in parts of the body and itchy skin. For more information on how this can be prevented and treated, visit the Resources tab.
Kidney problems | Canadian Cancer Society
Myelosuppression and Neutropenia
Myelosuppression means that the bone marrow does not produce as many cells as it normally would (National Cancer Institute, 2022). BC Cancer (2019a) explains neutrophils, megakaryocytes, and erythrocytes can be affected, different types of cells the originate from the bone marrow. Having decreased neutrophils can limit the body’s immune response, as neutrophils take part in the fight against pathogens right away. If a fever occurs when a person has neutropenia, this is referred to as febrile neutropenia (Patel & West, 2017). Neutropenia is a term that means the bloodstream has a low level of neutrophils. When a person has neutropenia they are more likely to have an infection. It is possible to receive infections from other people or from organisms that normally live in or on your body. Normally these organisms would be handled by your body, but with the reduced levels of neutrophils your body has a harder time regulating these entities. BC Cancer (2019a) explains that 45% of people who have undergone cancer treatment will have sepsis. Sepsis happens the body reactions very strongly to an infection (Sepsis Canada, 2023).
Common symptoms to look for are fatigue, lethargy, and wound characteristics such redness, swelling, pain, along with a sore throat, rash or diarrhea (Lymphoma Canada, 2023). If you find you are bruising quite easily or if you do bleed that you bleed for an extended period of time, contact your doctor right away.
For more information visit the Resources tab.
Phlebitis
Phlebitis is a condition where a needle used for chemotherapy is causing inflammation in the vein (Canadian Cancer Society, 2023w). You may notice the area where the needle was inserted is now feels painful, is swollen, has a noticeable warmth and is reddened. These signs of phlebitis can be caused by the type of needle, the medication running through the IV or the duration the IV is placed in your body. If these signs occur the needle is commonly taken out and inserted elsewhere. A warm compress that is moist can help lower the amount of inflammation. For more information visit the Resources tab.
Side effects of chemotherapy | Canadian Cancer Society
Sleep Disturbances
Sleep problems are related to having cancer (Canadian Cancer Society, 2023y). You may find it hard to stay asleep, fall asleep in the first place, or waking up earlier than desired. Sleep apnea occurs when breathing is interrupted during sleep, and then recovers. Insomnia is a very common sleep problem that is characterized by having trouble drifting asleep and maintaining sleep without waking up. Sleep is important as it helps booster your mood, coping and immune system. Without enough sleep you may have trouble recalling things and thinking without difficulty. For more information visit the Resource tab.
Sleep problems | Canadian Cancer Society
Changes in weight and eating habits
Eating can be a challenge when you are being treated for cancer (Government of Alberta, 2022). You may have certain side effects of treatment such as feeling fatigued, constipation, mouth sores and increased weight. For suggestions on how to find an eating plan that works for you, visit the Resource tab.
Learning About Nutrition Problems During Cancer Treatment (alberta.ca)
Loss of Appetite
Having a decreased appetite means that you no longer have an interest in eating, which is common during a person’s cancer journey (Canadian Cancer Society, 2023q). The side effects that come along with treatment can be contributing factors. To explore how loss of appetite may be detected and managed, please refer to the Resource tab.
Loss of appetite | Canadian Cancer Society
Urinary Problems (including urinary incontinence)
Some cancers cause the bladder to develop problems that include bleeding, blockages and infections (Canadian Cancer Society, 2023b). To explore how bladder problems can present, typical causes, prevention and management, refer to the Resource tab.
Bladder problems | Canadian Cancer Society=
Sexual Health
BC Cancer (2019b) explains that cancer can cause changes in your sexual health. These changes may last a short period of time or for the long-term. It is important to have a conversation with your partner about what you are experiencing, and to reach out to your healthcare team for guidance. Common reasons for changes in sexual health, what to talk about with your partner, ways to manage the changes, and additional resources can be accessed under the Resource tab. The Canadian Cancer Society (2020b) has additional information on changes, causes and management options for issues that affect female sex organs. For information on issues that affect male sex organs, such as common challenges, causes and management options, please visit the Resource tab (Canadian Cancer Society, 2020c)
Sexual_health_cancer.pdf (bccancer.bc.ca)
Sexual problems – female sex organs | Canadian Cancer Society
Sexual problems – male sex organs | Canadian Cancer Society
Fever
Cancer Care Ontario (n.d.a) has a patient guide for help identifying when a fever is present, and helpful ways to make sure your temperature reading is accurate. If you are concerned about a temperature reading it is best to contact your healthcare team or visit your local emergency room. Refer to the Resource tab for more information. The Centers for Disease Control and Prevention (2022) of course maintains that when you are having chemotherapy and you have a fever, it is always important to seek out medical help immediately, as this could be the only sign of a serious infection. If you seek out medical help at an emergency room, tell the staff that you are undergoing chemotherapy. For other helpful tips please visit the Resource tab.
Watch Out for Fever | Preventing Infections in Cancer Patients | CDC
Delirium
The Canadian Cancer Society (2023k) explains that delirium happens when a person’s cognitive status rapidly shifts over a period of hours to days. For more information on causes, how to detect delirium, manage the condition, as well as for ways family members can cope with the situation, please visit the Resource tab for more information.
Delirium | Canadian Cancer Society
Bowel Function
Bowel perforation refers to a hole that has developed in an intestinal wall (Canadian Cancer Society, 2022a). This can cause intestinal fluid to leak out of the hole. An abscess, or a clump of pus, can occur. A life-threatening infection in the abdomen, called peritonitis, can also develop. This condition requires immediate medical attention. For specific causes, how to detect a bowel perforation, and the management plan, please visit the Resource tab.
A bowel obstruction means the normal flow of intestinal contents cannot move past a partial or complete stoppage (Canadian Cancer Society, 2023d). For the causes of a blockage, symptoms that can appear and management, please visit the Resources tab for more information.
Bowel obstruction | Canadian Cancer Society
Bowel perforation | Canadian Cancer Society
Constipation
Constipation refers to a difficulty passing stool that has become hard and dry (Canadian Cancer Society, 2021). This can happen if water leaves the intestines quickly, or if the stool does not move quick enough through the intestines. For more information on causes, how to recognize it, prevent it and manage it, visit the Resources tab.
Constipation | Canadian Cancer Society
Hormonal Symptoms
Hormones are created by the body to carry messages via the bloodstream (Cancer Research UK, 2022). Certain cancers can affect the hormones in the body. To find out more about the role of hormones, the cancer treatments that can alter them, how to recognize changes in hormones and ways to manage changes, please visit the Resources tab.
Sex hormones and cancer | Coping with cancer | Cancer Research UK
Bone Health
Alterations in the health of bones can happen when can occurs in childhood (Canadian Cancer Society, 2023c). The normal growth and development of bones can be altered, resulting in conditions such as weak bones or scoliosis, where the spine begins to curve. For specific causes, underlying risk factors, symptoms to watch for, prevention and management options, visit the Resources tab.
Bone and muscle problems | Canadian Cancer Society
Dyspnea
The Canadian Cancer Society (2022c) explains that dyspnea, also known as shortness of breath, is experienced as discomfort or a lack of feeling that enough air is entering your lungs. When cancers affect the lungs it is common to experience dyspnea. There are many different causes, symptoms, and ways to manage this side effect, which can be found by visiting the Resources tab.
Shortness of breath (dyspnea) | Canadian Cancer Society
Lymphedema
When swelling prevents the normal flow of lymph through the tissues, you may experience lymphedema (Canadian Cancer Society, 2023). It commonly occurs when there is there is a removal or injury to a lymph node. An increase in the number of lymph nodes affected will increase the chances of developing this side effect. For explanations on why lymphedema occurs, how to detect its symptoms, how to prevent it from happening, and what treatment is available, visit the Resources tab.
Lymphedema | Canadian Cancer Society
Oral Care
There are several different things that can affect the integrity of the mouth. If you have concerns about any of the following, reach out to your healthcare for direction.
Oral Bacterial Infections can present as severe gingivitis, periodontal abscesses or periodontal disease (Ontario Health, n.d.). Symptoms to look out for include pain, redness, swelling, tenderness, fever, pus or a foul odor. Treatment include use of medications such as antibiotics and having a dentist take out the infected tissue. It is important to practice good oral hygiene, which includes flossing, brushing, applying moisture to your mouth, use lip moisturizer and rinsing your mouth out. The link for more information can be found in the Resources tab.
For a more detailed outline of how to care for your mouth, please visit the link for Ontario Health (n.d.) provided in the Resources tab. You will find as you scroll down a section on patient guides. The guide labelled “Patient Guide” has an in-depth look at mouth care. There is also the “Cancer Drug Side Effect Sheet” and important ways to prevent mouth problems via the Resources tab.
Information on Dysguesia can be found by accessing the Ontario Health (n.d.) link and accessing the “Dysguesia Algorithm.” found under the Resources tab. Dysguesia happens when you perceive all foods to have a particular characteristic, this may be a sour or a sweet taste (Cleveland Clinic, 2023). For some there are no changes to their diet, for others the unpleasant taste can cause alterations in diet (Ontario Health, n.d.). Ontario Health (n.d.) has a variety of suggestions for what to do if food tastes metallic, or sweet, bitter, etc. The “Dysguesia Algorithm” has a lot of suggestions you can access. All of which are found under the Resources tab.
Ontario Health (n.d.) has a “Dysphagia Algorithm.” Dysphagia can present as oropharyngeal, where swallowing, coughing, and food are difficult to control. You may find that food stays in your throat despite trying to swallow it. Esophageal dysphagia can make you feel that food is stuck in your throat and that it may come back up. Weight loss, pneumonia and alterations in how you eat are common for both types of dysphagia. Specific cancer patient populations that are more prone to developing dysphagia, what treatments may lead to this condition and how to prevent it are listed in this document, found under the Resources tab. Several swallowing exercises can be performed to improve your quality of life.
Ontario Health (n.d.) has a “Hematopoietic Stem Cell Transplantation Oral Care Algorithm.” Hematopoietic Stem Cell Transplantation (HSCT), is used for supplementing bone marrow in various cancer treatments (Khaddour et al., 2022). HSCT can lead to different conditions, including oral mucositis, where ulcers develop in the mouth (Ontario Health, n.d.). Graft versus Host Disease happens when the body sees the new tissue as a threat. Infections can happen for a variety of reasons including neutropenia and dehydration. There are many different symptoms for each of these conditions. If are concerned about your oral health please contact your healthcare team. For help with oral care recommendations and possible prevention/treatment the “Hematopoietic Stem Cell Transplantation Oral Care Algorithm” has a lot of information. This can be found under the Resources tab.
Fungal Infections Algorithm
Oral fungal infections are another form of oral infection Ontario Health (n.d.). There are specific forms of oral fungal infections that can be found using the website link in the Ontario Health (n.d.) link under the Resources tab, and then clicking on “Fungal Infections Algorithm.” Common factors that can cause fungal infections include dry mouth, using antibiotics, having neutropenia and having dentures. If a fungal infection develops there are different medications and options for treatment.
Viral Infections Algorithm
Viral infections can happen during cancer care (Ontario Health, n.d.). Some of the risk factors include neutropenia, oral herpes simplex virus and stress. The management and prevention pieces can be accessed by clicking on the “Viral Infection Algorithm” on the website provided in the Ontario Health (n.d.) link under the Resources tab.
Medication-Related Osteonecrosis of the Jaw Algorithm
There need to be three criteria met for medication-related osteonecrosis of the jaw (MRONJ) condition to be diagnosed (Ontario Health, n.d.). First, a bone protruding through the interior of the mouth is seen or can be felt. Second this condition has not been fixed within 8 weeks. Third, the mouth has not received radiation. Some of the risk factors include the use of certain medications and how long prescriptions were used. Further information on what may cause this condition, how it may be prevented, and how it is treated can be found using the link for Ontario (n.d.) in the Resources tab, then clicking on “Medication-Related Osteonecrosis of the Jaw Algorithm.”
Mucositis Algorithm
Mucositis occurs when the mouth is swollen and irritated (National Library of Medicine, n.d.). You may have mucositis if you notice your mouth is painful, experience mouth sores, are bleeding inside your mouth or if you have an infection in your mouth. To explore the causes of this condition and how it is managed, visit Ontario Health (n.d.) which can be found in the Resources tab, and then click on “Mucositis Algorithm.”
Stomatitis Algorithm
Stomatitis includes inflammation and ulcers in the mouth (Hennessy, 2022). Ontario Health (n.d.) explains some of the risk factors for this condition include certain medications and therapies. Some of the symptoms that may be experienced are thick secretions, pain and odynophagia, also known as pain, which accompanies swallowing. For further information on prevention and treatment options, visit the website link for Ontario Health (n.d.) under the Resources tab, and then click on the “Stomatitis Algorithm.”
Trismus Algorithm
According to Cleveland Clinic (2022b) trismus occurs when the muscles of the jaw contract into painful spasms. Ontario Health (n.d.) explains that tumours near the jaw, infection, and surgery are among some of the risk factors associated with this condition. For more information on prevention and management visit the website link for Ontario Health (n.d.) under the Resources tab, and then click on the “Trismus Algorithm.”
Xerostomia and Salivary Hypofunction Algorithm
Ontario Health (n.d.) explains that xerostomia refers to a dry mouth and salivary hypofunction means saliva is not entering the mouth as quickly as it was. There are many ways to prevent and treat these conditions, which can be found in the “Xerostomia and Salivary Hypofunction Algorithm” by clicking on the website link for Ontario Health (n.d.) in the Resources tab.
Head and Neck Cancer Alliance. (2020, March 16). Managing oral mucositis (mouth sores) during and after treatment . https://www.youtube.com/watch?v=5U8jIiX-zjl
Video
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Memory and concentration changes
The Canadian Cancer Society (2023g) explains that how you think can change due to the cancer or its treatment. Some of the thinking abilities that are included are judgement, memory and communication. To explore the treatment and the management of cognitive changes, and the symptoms that can occur in adults and young children, visit the Resources tab.
Cognitive problems | Canadian Cancer Society
Chemo brain
Chemo brain refers to the foggy thinking and remembering that can occur because of chemotherapy (Cleveland Clinic, 2023). While this usually only resolves past the short-term, it can continue after the end of treatment. It is common for tasks to take more time, but many people explain that this is manageable. Further information on chemo brain, including the symptoms, the underlying causes, prevention and management (Government of Alberta, 2021), visit the Resources tab.
Chemotherapy Brain Fog (Chemo Brain): Symptoms & Treatment (clevelandclinic.org)
Learning About Chemo Brain (alberta.ca)
Neurocognitive functions
To explore how breast cancer and other cancers can impact how the brain functions, visit the Resources tab for a research article.
Cognitive Impairment Associated with Cancer – PMC (nih.gov)
Menopause
While menopause commonly starts at 50, it can be induced b cancer treatment (Canadian Cancer Society, 2023ac). For specific reasons why this happens, the symptoms you may experience, and how it is managed, visit the Resources tab for more information.
Treatment-induced menopause | Canadian Cancer Society
Nerve damage
Nerves can be damaged by some cancer treatments (Canadian Cancer Society, 2023s). Cancers that happen during childhood can also cause nerve issues experienced later in life. For more information on the causes of nerve damage, the symptoms, and ways to prevent and manage this side effect, visit the Resources tab.
Nerve damage | Canadian Cancer Society
Osteoporosis
The Canadian Cancer Society (2022b) explain that osteoporosis occurs when bones break down. This can result in a greater risk of bones fracturing. This is more commonly experienced by elderly persons, but some cancer treatments can lead to this side effect. For additional information on specific causes, the symptoms that may be experienced, and ways to treat and manage this condition, visit the Resource tab for more information.
Osteoporosis | Canadian Cancer Society
Pain
Ontario Health (2020) has a guide for how to manage pain. The website link in the reference for Ontario Health (2020) can be accessed for more information. There are different types of pain you may experience. Bone pain can be described as sharp, pulsing, a throb or happening in your bones. Movement may make it worse. Nerve pain, known as neuropathic pain, can feel like a burning, stabbing or shooting sensation. You may experience this when different objects or water and wind make contact with your skin. Soft tissue pain, or visceral pain, is when the tissues that go around your organs become painful. You may find your tendons and muscles have a squeezing or dull pain, which may be deep inside you. These types of pain can happen due to cancer treatment, growth of a tumour or medical tests. If you have pain that is new, hurts you when you breathe, causes your legs to become weak or will not go away, then it is best to immediately reach out to your health care team. That may be your doctor or nurse. Ways to manage your pain include taking medication for the pain, being active, trying therapies that help with mindfulness, and other suggestions your health care team recommends. Your healthcare team will guide you through the process.
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Summary
Over this hub we discussed the goals of cancer screening and how it can help healthcare professionals work as a team with patients to understand their physical, psychological, and any other concerns that may be affecting them during their cancer journey. There are multiple different cancer screening tools that screen for a variety of symptoms over psychosocial, physical, and practical domains of needs. Examples of standardized cancer screening tools include ESAS-r, CPC, PPF, and the COMPASS and these can be used in conjunction with one another to comprehensively screen patients (CJAJ, 2009). Another important area of focus for assessments is sexuality and self-image with cancer patients. Sex and sexuality can be a difficult and uncomfortable conversation for patients to have, but it is important the patient knows they are supported and have resources to access when and if they require them (BC Cancer, 2018). The FICA tool assesses patients’ connection to their spirituality through 4 topics: Faith, Importance and Influence, Community, and Address/Action in Care (GWish, 2021). Telephone screening is an important method of assessment that can be an easier barrier-free alternative for patients. Symptoms and symptom management can be assessed over the telephone with the correct training and guidelines. As well as this, MI can be used over the telephone to help strengthen the patient’s motivation to change and learn to become more involved in their care (Ottawa Hospital Research Institute, 2020).
References
- American Cancer Society. (2021). How Cancer and Cancer Treatment Can Affect Sexuality. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/how-cancer-affects-sexuality.html
- BC Cancer. (2023). Symptom & Side Effect Management Resource Guide. http://www.bccancer.bc.ca/health-professionals/clinical-resources/pharmacy/symptom-side-effect-management-resource-guide
- BC Cancer. (2018). Symptom Management Guidelines: INTIMACY AND SEXUALITY. http://www.bccancer.bc.ca/nursing-site/Documents/8.%20Intimacy%20and%20Sexuality.pdf
- BC Cancer. (2018). Symptom Management Guidelines: PAIN http://www.bccancer.bc.ca/nursing-site/Documents/8.%20Intimacy%20and%20Sexuality.pdf
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Canadian Partnership Against Cancer [CPAC]. (2017).
Fertility challenges a burden for adolescents and young adults with cancer: new report.
Retrieved from
Fertility challenges a burden for adolescents and young adults with cancer: new report
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Canadian Partnership Against Cancer [CPAC]. (2015). Video for Clinicians about patient-reported outcomes. Retrieved from
Video for clinicians about patient-reported outcomes
- Cancer Care Alberta. (2021). Putting Patients First (PPF). Retrieved from https://www.albertahealthservices.ca/assets/info/cca/if-cca-putting-patients-first-virtual.pdf
- Cancer Care Manitoba. (2021). Comprehensive Problem And Symptom Screening (COMPASS). Retrieved from https://www.cancercare.mb.ca/export/sites/default/Patient-Family/.galleries/files/your-first-visit-files/COMPASS.pdf
- Cancer Care Ontario [CCO]. (2021c). Intimacy and Sex: For people with cancer and their partners. Retrieved from https://www.cancercareontario.ca/en/symptom-management/35051
- Cancer Journey Action Group [CJAG]. (2009). Guide to Implementing Screening for Distress, the 6th Vital Sign: Moving Towards Person-Centered Care.
- Fitch, M. I. (2008). Supportive care framework. Can Oncol Nurs J , 18(1), 6-24. doi:10.5737/1181912×181614
- National Cancer Institute (2019). Breast Cancer Assessment Tool: Online Calculator. https://bcrisktool.cancer.gov
- Ottawa Hospital Research Institute. (2020). Remote Symptom Practice Guides for Adults on Cancer Treatments of the Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Team.
- The George Washington Institute for Spirituality and Health [GWish]. (2021). Monitoring Effectiveness of FICA Tool. Retrieved from https://smhs.gwu.edu/spirituality-health/program/patient-research/monitoring-effectiveness-fica-tool
- University of British Columbia, Continuing Professional Development, Faculty of Medicine (UBC CPD). (2022). Motivational Interviewing. https://ubccpd.ca/learn/learning-activities/course?eventtemplate=137-motivational-interviewing
- University of Victoria. (2020). Self-Management British Columbia: Motivational Interviewing. https://www.selfmanagementbc.ca/motivationalinterviewing
- World Health Organization [WHO]. (2016). Planning and Implementing Palliative Care Services: A guide for programme managers.
Resources
- BC Cancer. (2024, April). EPICC – The early symptom indicators for cancer care screening program. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/our-services/centres-clinics/bc-cancer-vancouver/epicc
- BC Cancer. (2024, April). cancer screening. Provincial Health Services Authority, BC Cancer, British Columbia. http://www.bccancer.bc.ca/health-info/screening
- BC Cancer. (2024, April). measuring patient experience. Provincial Health Services Authority, BC Cancer, British Columbia.
- BC Cancer. (2024, April). about our cancer statistics. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/health-info/disease-system-statistics/our-cancer-statistics
- BC Cancer. (2024, April). symptom management. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management
- BC Cancer. (2024, April). sexual health. Provincial Health Services Authority, BC Cancer, British Columbia.
- BC Cancer. (2024, April). symptom management. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management
- BC Cancer. (2024, April). symptom management and side effect management resource guide. Provincial Health Services Authority, BC Cancer, British Columbia.
- BC Cancer. (2024, April). pain and symptom management. Provincial Health Services Authority, BC Cancer, British Columbia.
- BC Cancer. (2024, April). risk factors. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/screening/breast/breast-health/risk-factors
- BC Cancer. (2024, April). high risk clinic. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/our-services/services/hereditary-cancer/high-risk-clinic
- BC Cancer. (2024, April). symptom management. Provincial Health Services Authority, BC Cancer, British Columbia.
http://www.bccancer.bc.ca/health-professionals/clinical-resources/nursing/symptom-management
Images
CT Senate Republicans. (2021). [Somers Mammogram Breast Cancer Awareness Month]. Flickr. https://flic.kr/p/2mCFfiU
Puuiki Beach. (2017). [Scale-A-Week]. Flickr. https://flic.kr/p/GLDYvX