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 cause
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 more
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 the
need for qualified professiona ls. For assistance in oncology nursing qualifica
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 clinica
l, psychological, social, spiritu al, political and ethical. As well as critical
thinking, emotional intelligence, leadership, ability to guide the team to deve
lop and implement research-based m anagement results and more specialized treatm
ent and care at the end of life due to cancer progression. According to INCA, pr
imary prevention is any action aime d at reducing people's exposure to risk fact
ors for cancer, aiming to reduce the incidence of the disease. Already covers th
e secondary prevention early diagnos is and immediate treatment, increasing the
chances of cure, providing improved q uality of life and reducing mortality rate
s (BRAZIL, 2002). The nurse's role is indispensable to the act of taking care, a
s among its powers is a direct action in shares of primary and secondary prevent
ion in cancer control, developing the educational actions, legislative measures
supporting and aiding in early diagnos is. In addition to the acts of assistance
in treatment, rehabilitation, palliati ve care and care to family, and also in
the development of integration actions with professi onals of the multidisciplin
ary team and the identification of occupational risk factors for nursing practic
e in care for cancer patients. The disease turns man subject of intent for the s
ubject of attention (and Gala Bressi, 1997). The dise ase triggers many reaction
s in stressful both patient and family, such as anxiet y, denial, shame, guilt a
nd uncertainty, anger, among others. The examinations, diagnosis, treatment, bod
y changes, reaction of family and friends, directly int erferes with the individ
ual's adaptation to the new situation. When ill, it is c ommon 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 nosis in a particular
way because of his personality, whose characteristics are unique to each person
, their ability to deal with problems and frustrations, the advantages and disad
vantages resulting from the position of the patient. Emphas 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, both 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 lifestyle 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 remove tumors, thus damaging t
he structure of the body, affecting the appearance and integrity of the individu
al narcissistic. But there may be the acceptance reaction 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 closer relationship with patients. B
iasoli (2000) also believes that truth should never be hidden from t he patient.
Hence the importance of communication in nursing, a fundamental cond ition for
there to be significant and positive influence in the treatment of pat ients reg
ardless of pathology. Every procedure performed in Communication is essential, t
herefore attention to language, avoiding the use of professional jargon or techn
ical terms when communicating with the patient in o rder to have clarity and und
erstanding, this is also a way to show respect. 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 evaluat
e your feelings, and that silence in itself encourages the patient to verbalize
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, anger a
nd depression (BELLERT, 1989, apud Stefanelli, 1993). So it has given importance
t o the play, it contributes significantly both in recovery and in the acceptan
ce and encouragement to continue the treatment, especially of children and adole
sce nts. It aims at the strengthening of the relationship, avoiding the deperson
aliz ation of the individual, an act frequently, so the actual nursing has 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 naming 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 understood tha
t you ca n not define maturity, because there are cases where the patient appare
ntly insp ired short term and lives far beyond what was estimated, as there are
cases wher e the opposite occurs. For reasons like these, it is necessary to mak
e a plan ai med at individuals as unique, thereby avoiding comparisons and estab
lishing dead lines. The cancer is no longer death sentence, but the company stil
l ranks as th e stigma. It is labeled as a fatal disease that affects the future
and, despite technological advances and resulting media coverage in their thera
peutic success es. Nurses assist the newly diagnosed patients who receive therap
y or who are fi rst treated appellant, giving you the due explanations already o
n admission, it makes him come to have an idea of what will confront. Exposing t
he family, the strategies of the care process and ther apy, because the greater
the understanding of the family about the diagnosis and treatment 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 be 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 changes 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 tissue damage and activatio
n of peripheral neuroreceptors (receivers of painful sensati ons). Pain receptor
s (nociceptors) are nerve endings, free skin that respond onl y to intense stimu
lation, potentially harmful. This stimulus can be either mecha nical, thermal an
d chemical industries. Must - take into account these factors i n order to have
understanding of the behavior of the patient, pay attention 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 patients with treat ment in genera
l, is to make them more independent as possible, encourage them to return to his
routine, even in a more sleek and avoiding too much 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 important to the presentat ion of the p
hysical space where the unit will do the treatment indicated, and ex planations
about the procedure to be used in a language easy 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 nursing 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 health promotion, so you should make it
conscious of its role as caretaker. The nursing staff is the link between the p
r ofessionals of the multidisciplinary team, which has closer relations with bot
h the patient and with his family, so has 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 patie n
t, worsening its framework. Thus, it should be noted that the relationship is h
armonious and balanced, avoiding the actions of its members to interfere negativ
ely in the patient's taking steps in conjunction with the team. The established
division of roles between the members is necessary because the family members a
c companying their loved one affected by cancer in accordance with its array 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 even in
ca se of hospitalization, among other responsibilities. It is therefore necessa
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 including
lack o f time, tiredness, inability to leave the patient alone and feelings of g
uilt ab out being amused while the patient is suffering. There are other 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 for yourself a
nd avoid burn out. Hospitalization was the most common indication in care for ca
ncer patients, especially children, however, much focus has been given to deinst
itutionalizati on, made possible through the outpatient segment and / 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 professional relationship
patient because the patient puts his life at the hands of people who headed even
professionals, are unknown as far as their skills. For children, we must unders
tand the particularity of their world in each evolut ionary step, confers the co
mpetence of a nurse care awareness, develop entertain ing activities for childre
n and their families. Emotional support for profession als dealing 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 temperatur 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 and, ther efore, use approp
riate techniques to assess pain. Kattlove and Winn (2003) empha size that, espec
ially cancer survivors have needs special care, since all patien ts have the ris
k of recurrence of primary tumor or may develop a secondary focus as a result of
genetic susceptibility or previous treatments, beyond 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. definition, is used from diagnos
is to the end of life a person with cancer. According to Patricia A . Ganz, dire
ctor of prevention research and cancer control at the University of California,
the mass of survivors tends to increase due to improved diagnosis an d treatment
. He adds that the theme of survival has been neglected by the medica l communit
y and there are few guidelines on how to monitor 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 in 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 explain 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 imminent death, which is a typical psycholo
gical reaction. Ther e are several treatment modalities, and among them, chemoth
erapy is the most fre quent, with or without 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 of
te n consists of a combination of drugs to be ineffective if used alone, because
th ere are subpopulations of tumors cells with different sensitivity to antican
cer drugs. The mechanisms of drug action are different, but always end up causin
g an injury to cellular DNA, as an "iron bar that locks a gear" makes it impossi
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 in norm
al ce lls is the cause of side effects such as nausea, vomiting and decreased im
munity , the effect on white blood cells and red. The doctor will need blood 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), orally 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 oncology, when c
hemotherapy is an outpatient, returning home is the same day. Among nursing acti
ons are eva luated on a daily basis or for outpatient treatment that is periodic
, skin and a ppendages, and the place used for infusion, guide patients as to av
oid exposure to direct sunlight, especially during the period from 10 to 14 hour
s; Targeting use of sunscreens with SPF 15 or more on sun-exposed areas; Gearing
use lightwei ght clothing with long sleeves to cover your arms and use of scarv
es or hats, in struct patient to use mild soap and to take bath with just warm w
ater; Target for not using abrasive solutions to clean the skin 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 chan ges in their body im
age, be aware of the changes in the epidermis of the scalp; observe how the poss
ible changes in the eyeball due to a drop of eyelashes and e yebrows; provide em
otional support to patients, assist in adapting to change in appearance and self
-esteem. Can be used as primary treatment (in leukemias, lymp homas, testicular
cancer), but is usually an adjuvant (after surgery), or 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 effects, mainly through injury
of normal tissues adjacent to the tumor. After the diagnosis and chosen therapy
and quality of radiation, determine the amount of radiation to b e used depends
on the tumor type and volume to be irradiated. We must explain th at nursing pro
cedures. For example, the use of "detention order", also known as "frame", since
the precision is crucial, especially if radiotherapy 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 treatment to prevent t he patient
from moving during treatment. An additional benefit is that the entry points of
the beams of treatment may be marked on the plastic surface without t he tattoos
. Tattoos are risks with ink made in the skin, outlining the region to be irradi
ated, and parts will be protected through the use of lead or specially designed
for your treatment. These marks must remain throughout treatment. Afte r marked
skin, the guidance given is that it does not wash 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 radiation, 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 irradiated 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 bett
er quality of life. According to Dr.Císio Brandão, medical oncologist specializing i
n Palliative Medicine in London, England and of the Department of Palliative C a
re at the Cancer Hospital of São Paulo, what happens today in Brazil, is the pa tc
hy provision of treatment to patients in palliative care that are not included i
n most of the time, which can result in a financial burden not only to patient s
and institutions, but the very life of the patient. Currently there are insuff
icient data [Stanton and Caan, 2003] pointing to the need for devoting attention
to the health of health professionals, especially mental health. For France, th
e Burnout Syndrome in stress, is characterized by a set of signs and symptoms o
f physical exhaustion, mental and emotional, as a result of poor adaptation 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 that docto
rs and nurses have higher levels of emotional disturbance than the other high le
ve l professionals. The mental suffering inherent in work in hospitals [Pitta, 1
991 ] is common to all these professionals. This involves factors such as uncert
aint y, stress at work because of the importance of dealing with risks, the conc
ern a bout the execution of procedures, noting that the minimum mistake can be d
eadly, so it gives even low self-esteem. Elisabeth Kübler-Ross, psychiatrist and p
ioneer in the investigation of death and dying, he created the model of Kübler-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 aling 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 neg otiation, depres
sion and acceptance. Hence we see the need for improving their 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 damage in the emotional
sense for both sides and in the professional sense. The best metho d to use agai
nst cancer is prevention by adopting simple measures. It is 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 your quality of l ife, prom
otion campaigns prevention and information on the disease and educate s ociety a
bout the importance of it. Thus, it is important to pass 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 renewed vision and criti cal th
inking, but encourage more human so there is differential. There is concer n fro
m nurses about the implementation of the systematization of nursing care as a me
ans to improve care to patients with malignant disease and their family. Th e ch
ange in scheduling and planning of nursing actions should be done differentl y f
rom the former employee returned to the reference model biomedical, seeking a hu
manized care, without ignoring the ethical dimensions, cultural, historical a nd
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