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Nursing Care in Oncology Cancer is conceptualized as a biochemical disorder, cau

sed by the uncontrolled g rowth of cells that invade the tissues and organs and
can spread in metastasis t o other body regions. This is the third leading caus
e of death in Brazil with ap proximately 110,000 deaths per year, surpassed only
by cardiovascular diseases a nd external causes, such as violence. According to
these figures, the care for p atients with cancer have been intensified and mor
e specialized, such care nursin g care provided in a holistic manner. Increasing
the number of people diagnosed with cancer inspires special care, as well as th
e need for qualified professiona ls. For assistance in oncology nursing qualific
a tion is required of nurses in ca re to cancer patients through a solid base of
t echnical and scientific knowledge of care for oncology nursing, based on clin
ica l, psychological, social, spiritu al, political and ethical. As well as crit
ical thinking, emotional intelligence, leadership, ability to guide the team to
deve lop and implement research-based m anagement results and more specialized t
reatm ent and care at the end of life due to cancer progression. According to IN
CA, pr imary prevention is any action aime d at reducing people's exposure to ri
sk fact ors for cancer, aiming to reduce the incidence of the disease. Already c
overs th e secondary prevention early diagnos is and immediate treatment, increa
sing the chances of cure, providing improved q uality of life and reducing morta
lity rate s (BRAZIL, 2002). The nurse's role is indispensable to the act of taki
ng care, a s among its powers is a direct action in shares of primary and second
ary prevent ion in cancer control, developing the educational actions, legislati
ve measures supporting and aiding in early diagnos is. In addition to the acts o
f assistance in treatment, rehabilitation, palliati ve care and care to family,
and also in the development of integration actions with professi onals of the mu
ltidisciplin ary team and the identification of occupational risk factors for nu
rsing practic e in care for cancer patients. The disease turns man subject of in
tent for the s ubject of attention (and Gala Bressi, 1997). The dise ase trigger
s many reaction s in stressful both patient and family, such as anxiet y, denial
, shame, guilt a nd uncertainty, anger, among others. The examinations, diagnosi
s, treatment, bod y changes, reaction of family and friends, directly int erfere
s with the individ ual's adaptation to the new situation. When ill, it is c ommo
n to an exacerbatio n of sensitivity and vulnerability, on the occasion of th e
sudden changes which should address and submit. Each individual faces the diag n
osis in a particular way because of his personality, whose characteristics are u
nique to each person , their ability to deal with problems and frustrations, the
advantages and disad vantages resulting from the position of the patient. Empha
s izing that the state has a strong mental connection with the operation of the
bo dy and mind that th e patient is active in their recovery or improvement, bot
h as sociated with depr ession may occur at diagnosis or acceptance. For Biasoli
(2000 ), the first emot ion that arises is that of guilt, combined with lifesty
le habit s. Depression is usually consequent fear and anxiety about the unknown
future, f ear of mutilati on or permanent scars as a result of surgeries to remo
ve tumors, thus damaging t he structure of the body, affecting the appearance an
d integrity of the individu al narcissistic. But there may be the acceptance rea
ction in most unexpected tim es due to the same factors that lead to depression,
because the p atient accepts more easily the disease, seeking to learn what it
is and the proc edures that m ust be submitted. This makes his relationship with
the team which p rovides care , especially with nursing, as it always has close
r relationship with patients. B iasoli (2000) also believes that truth should ne
ver be hidden from t he patient. Hence the importance of communication in nursin
g, a fundamental cond ition for there to be significant and positive influence i
n the treatment of pat ients reg ardless of pathology. Every procedure performed
in Communication is essential, t herefore attention to language, avoiding the u
se of professional jargon or techn ical terms when communicating with the patien
t in o rder to have clarity and und erstanding, this is also a way to show respe
ct. It i

s for nursing, use techniques that help the patient in expressing their problems
. To listen and be attentive to what is not revealed verbally, so that there is
keen perception to identifying the real feelings, problems and needs. Silence i
s also important that the patient serves to reorganize your thoughts and evalua
t e your feelings, and that silence in itself encourages the patient to verbaliz
e t heir thoughts. Humor is a vital skill of communication and a mechanism that
ca n help patients and families, to relieve feelings such as fear, anxiety, ange
r a nd depression (BELLERT, 1989, apud Stefanelli, 1993). So it has given import
ance t o the play, it contributes significantly both in recovery and in the acce
ptan ce and encouragement to continue the treatment, especially of children and
adole sce nts. It aims at the strengthening of the relationship, avoiding the de
person aliz ation of the individual, an act frequently, so the actual nursing ha
s assum ed a posture divergent conditioned by the biomedical model. The concern
in valui ng th e individual, calling him by name and not mischaracterize it by n
aming it the nu mber of beds or the disease that presents and treating it so it
feels saf e and a ccepted without showing indifference or disregard. It was unde
rstood tha t you ca n not define maturity, because there are cases where the pat
ient appare ntly insp ired short term and lives far beyond what was estimated, a
s there are cases wher e the opposite occurs. For reasons like these, it is nece
ssary to mak e a plan ai med at individuals as unique, thereby avoiding comparis
ons and estab lishing dead lines. The cancer is no longer death sentence, but th
e company stil l ranks as th e stigma. It is labeled as a fatal disease that aff
ects the future and, despite technological advances and resulting media coverage
in their thera peutic success es. Nurses assist the newly diagnosed patients wh
o receive therap y or who are fi rst treated appellant, giving you the due expla
nations already o n admission, it makes him come to have an idea of what will co
nfront. Exposing t he family, the strategies of the care process and ther apy, b
ecause the greater the understanding of the family about the diagnosis and treat
ment possibilities will be the best contribution to this collaboration wit h the
patient and positi ve therapy. Chronic pain is common in cancer patients ma y b
e due to the primary tumor or its metastases, the anti-cancer therapy (surger y,
radiotherapy or che motherapy) and methods of diagnosis. In some situations, i
t may be related to p sychosocial causes, disable it and leads to harmful change
s in the organic, emot ional, behavioral and social. Currently, the predominant
me chanism recognized a s the chronic pain of cancer is tumor invasion, with tis
sue damage and activatio n of peripheral neuroreceptors (receivers of painful se
nsati ons). Pain receptor s (nociceptors) are nerve endings, free skin that resp
ond onl y to intense stimu lation, potentially harmful. This stimulus can be eit
her mecha nical, thermal an d chemical industries. Must - take into account thes
e factors i n order to have understanding of the behavior of the patient, pay at
tention to y our needs, but being aware of limits should be imposed not to make
them totally dependent on nu rsing, because one of the goals to achieve in patie
nts with treat ment in genera l, is to make them more independent as possible, e
ncourage them to return to his routine, even in a more sleek and avoiding too mu
ch stress, or re sponsibilitie s incumbent on it as well as provide guidance the
family about the offer of unco nditional support in his recovery. It is importa
nt to the presentat ion of the p hysical space where the unit will do the treatm
ent indicated, and ex planations about the procedure to be used in a language ea
sy to understand for p atients an d their companions, thus providing preliminary
points are in order to understand the importance of routine for the welfare of
the patient. Beware of i nformatio n overload or lack of them, one must know it
balanced them so that does not caus e harm to the patient. The dedication of nur
sing focused on the patient 's famil y should be in the sense of direction, but
should be afforded special at tention , knowing that it is an integral role in h
ealth promotion, so you should make it conscious of its role as caretaker. The n
ursing staff is the link between the p r ofessionals of the multidisciplinary te
am, which has closer relations with bot h the patient and with his family, so ha
s the task of paying attention to the me mb

ers. Reason for this attention is the fact that the family is a part of extreme
im portance because it can both cooperate to recovery as it can depress the pati
e n t, worsening its framework. Thus, it should be noted that the relationship i
s h armonious and balanced, avoiding the actions of its members to interfere neg
ativ ely in the patient's taking steps in conjunction with the team. The establi
shed division of roles between the members is necessary because the family membe
rs a c companying their loved one affected by cancer in accordance with its arra
y of we ather and other factors aggregates, delegating tasks as taking financial
issu es, both in patient follow-up consultations or during the treatment, and e
ven in ca se of hospitalization, among other responsibilities. It is therefore n
ecessa ry t o advise you not to neglect their health, their social life and your
physic al we ll being and emotional. This usually occurs for several reasons in
cluding lack o f time, tiredness, inability to leave the patient alone and feeli
ngs of g uilt ab out being amused while the patient is suffering. There are othe
r guideli nes to b e transmitted, how to make them understand that it is better
to opt for the trut h even when it seems the worst, tell them to listen to what
the entity has to sa y, either about their fears, feelings, doubts or any other
matter; cr y when ther e is a will, make them understand the importance of being
collaborat ors of the m ultidisciplinary team, guiding them to preserve time fo
r yourself a nd avoid burn out. Hospitalization was the most common indication i
n care for ca ncer patients, especially children, however, much focus has been g
iven to deinst itutionalizati on, made possible through the outpatient segment a
nd / or home ca re (Home Care). It is important that it be made to identify the
members of the m ultidisciplinar y team, for presentations to narrow x professio
nal relationship patient because the patient puts his life at the hands of peopl
e who headed even professionals, are unknown as far as their skills. For childre
n, we must unders tand the particularity of their world in each evolut ionary st
ep, confers the co mpetence of a nurse care awareness, develop entertain ing act
ivities for childre n and their families. Emotional support for profession als d
ealing with children is essential. Nursing care in palliative measures defi ned
by the actions of ph ysical contact by touch, which brings security and comfo rt
for the child, mothe r and family to enable them to handle the child in her la
p, diminishing sufferi ng, often caused by pain, let the child in a comfortable
p osition, noting poten tial regions for the formation of scabs, let the tempera
tur e warm and friendly environment, using consistent language and tone of voice
app ropriate, avoid unn ecessary handling, allow the child to express feelings
of los s and separation t hrough toys, always keep adequate analgesia for pain a
nd, ther efore, use approp riate techniques to assess pain. Kattlove and Winn (2
003) empha size that, espec ially cancer survivors have needs special care, sinc
e all patien ts have the ris k of recurrence of primary tumor or may develop a s
econdary focus as a result of genetic susceptibility or previous treatments, bey
ond the need o f psychologica l and social support. Therefore, cancer survivors
have different c are needs of many medical areas. The term 'survivor' by U.S. de
finition, is used from diagnos is to the end of life a person with cancer. Accor
ding to Patricia A . Ganz, dire ctor of prevention research and cancer control a
t the University of California, the mass of survivors tends to increase due to i
mproved diagnosis an d treatment . He adds that the theme of survival has been n
eglected by the medica l communit y and there are few guidelines on how to monit
or these people and ensu re them t he best start possible. Patients do not have
information on the late ef fects of treatment and are lost in the transition of
patients to survivors. For nursing, experience in practice and seeing patients i
n a situation of grave or i mminent death is a big challenge (SANTOS, 1996). The
role of nursing is a functi on of explaining that each case is particular, to e
xplain to the family to under stand the condition and understand their treatment
, leading to confidence in that tea m. This disease als o causes fear of imminen
t death, which is a typical psycholo gical reaction. Ther e are several treatmen
t modalities, and among them, chemoth erapy is the most fre quent, with or witho
ut radiotherapy, surgery, immunotherapy and hormone therapy.

The treatment protocol is established according to the type of tumor, its biolo
gical behavior, location, extent of disease, age and general condition of the pa
tient. Traditional chemotherapy fight cancer, but destroys it along with a mult
i tude of healthy cells. It was the first systemic treatment for cancer. Most o
f te n consists of a combination of drugs to be ineffective if used alone, becau
se th ere are subpopulations of tumors cells with different sensitivity to antic
an cer drugs. The mechanisms of drug action are different, but always end up cau
sin g an injury to cellular DNA, as an "iron bar that locks a gear" makes it imp
ossi ble to function, says Dr. Luciana Holtz de Camargo Barros is a psychologist
spec iali zing in Oncology and is responsible for Oncoguia site. The toxicity i
n norm al ce lls is the cause of side effects such as nausea, vomiting and decre
ased im munity , the effect on white blood cells and red. The doctor will need b
lood tes t to as sess and plan chemotherapy, and treatment will be administered
intraveno usly (ve in), intra-arterial (artery), intra-vesical (bladder tumors),
intrathec al (spina l fluid space in the spine) , intramuscular (muscle), orall
y and subcu taneously, by professional nursing personnel. It can be done at the
Center for D rug Therap y and the Division of Inpatient hospital or clinical onc
ology, when c hemotherapy is an outpatient, returning home is the same day. Amon
g nursing acti ons are eva luated on a daily basis or for outpatient treatment t
hat is periodic , skin and a ppendages, and the place used for infusion, guide p
atients as to av oid exposure to direct sunlight, especially during the period f
rom 10 to 14 hour s; Targeting use of sunscreens with SPF 15 or more on sun-expo
sed areas; Gearing use lightwei ght clothing with long sleeves to cover your arm
s and use of scarv es or hats, in struct patient to use mild soap and to take ba
th with just warm w ater; Target for not using abrasive solutions to clean the s
kin or in bath; inst ruct so as not to expose to extreme temperatures (excessive
heat or cold), Offer ing emotional support for the patient to work with the cha
n ges in their body im age, be aware of the changes in the epidermis of the scal
p; observe how the poss ible changes in the eyeball due to a drop of eyelashes a
nd e yebrows; provide em otional support to patients, assist in adapting to chan
ge in appearance and self -esteem. Can be used as primary treatment (in leukemia
s, lymp homas, testicular cancer), but is usually an adjuvant (after surgery), o
r before , the surgery (ne oadjuvant) or associated with radiotherapy, which is
the most w idely used metho d for tumors that can not be resected completely, or
for tumors that tend to ret urn to the same place after surgery. It has side ef
fects, mainly through injury of normal tissues adjacent to the tumor. After the
diagnosis and chosen therapy and quality of radiation, determine the amount of r
adiation to b e used depends on the tumor type and volume to be irradiated. We m
ust explain th at nursing pro cedures. For example, the use of "detention order"
, also known as "frame", since the precision is crucial, especially if radiother
apy is applied t o the head or neck. The frame is a special mold of transparent
plastic that cove rs the body part being treated and is fixed in the bed of trea
tment to prevent t he patient from moving during treatment. An additional benefi
t is that the entry points of the beams of treatment may be marked on the plasti
c surface without t he tattoos . Tattoos are risks with ink made in the skin, ou
tlining the region to be irradi ated, and parts will be protected through the us
e of lead or specially designed for your treatment. These marks must remain thro
ughout treatment. Afte r marked skin, the guidance given is that it does not was
h this region in the fi rst 24 h ours as it facilitates the setting of the ink.
After this time, the regi on can be washed with mild soap, but without scrubbing
. When these marks are wea k, the professional will retouch them so they do not
disappear completely. After the t reatment, ie the number of applications of rad
iation, and reassessmen t of the d octor radiotherapist, the marks of the fields
in the skin may be remov ed by was hing, but be careful not to injure an irradi
ated skin, which is already irritate d . Any injury to heal from that moment and
disappear over time. It tak es patienc e and follow the treatment prescribed by
doctors to alleviate the side effects. Palliative Care is the fourth guideline
established by the World Healt h Organiz ation (WHO) for cancer treatment, after
Prevention, Diagnosis and Treat

ment. But in Brazil this item is still unknown by most patients and, unfortunate
ly, by many health professionals. Aims to control pain and other physical sympt
o ms, psychological, spiritual and social, allowing patients and families a bet
t er quality of life. According to Dr.Csio Brando, medical oncologist specializing
i n Palliative Medicine in London, England and of the Department of Palliative
C a re at the Cancer Hospital of So Paulo, what happens today in Brazil, is the p
a tc hy provision of treatment to patients in palliative care that are not inclu
ded i n most of the time, which can result in a financial burden not only to pat
ient s and institutions, but the very life of the patient. Currently there are i
nsuff icient data [Stanton and Caan, 2003] pointing to the need for devoting att
ention to the health of health professionals, especially mental health. For Fran
ce, th e Burnout Syndrome in stress, is characterized by a set of signs and symp
toms o f physical exhaustion, mental and emotional, as a result of poor adaptati
on of t h e subject to prolonged labor, high stress and intense emotional charge
, and ma y be accompanied by frustration with you and work. Studies have shown t
hat docto rs and nurses have higher levels of emotional disturbance than the oth
er high le ve l professionals. The mental suffering inherent in work in hospital
s [Pitta, 1 991 ] is common to all these professionals. This involves factors su
ch as uncert aint y, stress at work because of the importance of dealing with ri
sks, the conc ern a bout the execution of procedures, noting that the minimum mi
stake can be d eadly, so it gives even low self-esteem. Elisabeth Kbler-Ross, psy
chiatrist and p ioneer in the investigation of death and dying, he created the m
odel of Kbler-Ros s proposed in his book On Death and Dying, published in 1969 ,
which proposes a description of five discrete stages at which people become de a
ling with loss, g rief and tragedy. According to this model, patients with termi
nal illnesses go through these stages, they are denial, anger, bargaining or ne
g otiation, depres sion and acceptance. Hence we see the need for improving thei
r k nowledge and sk ills to be able to act safely and effectively in the care of
canc er patients an d family care, with no neglect and without causing much dam
age in the emotional sense for both sides and in the professional sense. The bes
t metho d to use agai nst cancer is prevention by adopting simple measures. It i
s the res ponsibility of nursing, to warn the community to raise awareness about
the impor tance of im proving dietary habits, education to deal with the stress
of daily li fe in a wa y that identifies when the stress level is affecting you
r quality of l ife, prom otion campaigns prevention and information on the disea
se and educate s ociety a bout the importance of it. Thus, it is important to pa
ss this knowledge society, understanding and exercising the same care to you is
of high relevance. The rel ationship between nurses and cancer patients has been
rethought and chan ged con stantly, as the pattern of disease. The need for ren
ewed vision and criti cal th inking, but encourage more human so there is differ
ential. There is concer n fro m nurses about the implementation of the systemati
zation of nursing care as a me ans to improve care to patients with malignant di
sease and their family. Th e ch ange in scheduling and planning of nursing actio
ns should be done differentl y f rom the former employee returned to the referen
ce model biomedical, seeking a hu manized care, without ignoring the ethical dim
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