Page 48 nursing.elitecme.com Complete Your CE Test Online - Click Here ○ ○ Choose whole grains instead of foods with refined grains and high-sugar content. Of course, there is no guarantee that any or all of these measures will prevent any one person’s cancer, but as public health measures, they should reduce cancer risk overall. Dietary supplements for cancer prevention Patients and family will often inquire what they can take to prevent cancer. They might want to know about dietary supplements because they are interested in a natural approach to health. But dietary supplements are a broad category that can include vitamins and minerals, herbs, or botanicals (products made from plants). Others supplements are made from animal parts, algae, yeasts, fungi, or seafood, among many other things. Some dietary supplements have been shown to be beneficial for certain health conditions. For example, folic acid supplements used by women of childbearing age who may become pregnant reduces the risk of some birth defects. Another example is crystalline vitamin B12, which helps people over age 50, a time when many have a reduced ability to absorb naturally occurring vitamin B12 from foods. Although many herbal supplements are carefully grown, tracked, harvested, and prepared under clean controlled conditions, there are others that are not. Many supplements sold today have fillers and contaminants that are not on the label. Supplements have had to be recalled by the FDA because of proven or potential harmful effects. Reasons for these recalls include microbiological, pesticide, and heavy metal contamination; absence of a dietary ingredient claimed to be in the product; and the presence of more or less than the amount of the dietary ingredient claimed on the label. Although some may find it disappointing, there is nothing inherently safe about natural plants and animal parts unless they are well understood, carefully prepared, and properly used. Some of the most toxic substances and potent allergens in the world occur naturally. Hemlock and poison mushrooms are natural but are quite dangerous if taken internally. There have been some concerns about the content of many herbal preparations sold in the U.S. When herbal supplements have been purchased and tested by researchers, many of them have been found to contain contaminants or fillers. Some supplements did not contain any of the substances listed on their labels, which in 2015 led to legal action by the state attorney general of New York. One major supplement retailer signed an agreement to authenticate supplements and adopt new standards as a result. Unfortunately, a few manufacturers produce so-called natural supplements that are covertly adulterated with actual drugs that are known to have harmful side effects. For example, many weight loss products and “men’s supplements” contain prescription drugs (e.g., sibutramine, anabolic steroids, tadalafil), some of which have been banned by the FDA because they were harmful to human health. In fact, according to the IARC, androgenic (anabolic) steroids are probable carcinogens. It is also important for patients to know that dietary supplements do not have to prove effectiveness or safety before being marketed; they are considered safe until proven otherwise. The FDA regulates food supplements like food because it expects them to have no more effect than food does. The FDA also regulates claims that can be made by supplement sellers as well as the types of materials that are allowed in he supplements, but laws are sometimes broken. Based on the evidence about nutrition and dietary supplements, the American Cancer Society advises that it is better to eat healthy foods to obtain antioxidants and vitamins rather than take them as supplements. No dried supplement is equivalent to eating whole foods, fruits, and vegetables. Food is the best source of vitamins and minerals. Most vitamins and other supplements do not cause problems in normal doses, but high doses of supplemental vitamin E (taken alone), in one study, were linked to a slightly higher rate of prostate cancer in men who had lower levels of selenium in the body. Commonly available herbs cannot cure or prevent cancer Although some studies suggest that alternative or complementary therapies, including some herbs, might help patients cope with the side effects of cancer treatment, no herbal products have been shown to be effective for treating cancer. It is helpful to ask cancer patients open-ended questions about vitamins and herbal supplements and any other complementary therapies they may be using when reviewing their current medications. Health concerns for nurses treating cancer patients Nurses and caregivers who prepare and administer hazardous drugs need special training and procedures to avoid skin contact, splashes, and aerosols. Mechanical protection, such as compounding biologic safety cabinets, are used along with careful splash-minimizing procedures during drug preparation. Those administering dangerous and cytotoxic drugs should use personal protective equipment (PPE, such as disposable chemotherapy gloves, gowns, and goggles) for reducing the risks of splashes, aerosols, and other exposures. Used PPE must be disposed of appropriately, along with bags, syringes, tubing, and other administrative equipment. Reusable goggles should be carefully cleaned following procedures that minimize possible contamination of the health care worker or the work environment. NIOSH has a list of hazardous drugs in health care settings along with how those drugs were chosen and what those hazards are online at http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138_v3.pdf. Eye-wash stations and drenching hoses are also strongly recommended by OSHA in areas near where cytotoxic drugs are prepared and administered and near possible bloodborne pathogen exposures. These are intended to manage potentially hazardous splashes after the fact, but they are not a substitute for preventive measures. Summary This continuing education course covered cancer prevention, cancer nursing, early detection, myths about cancer and cancer prevention, drug interactions, dangers to the nurse and the patient from cancer treatment, financial issues, and standards of care. Cancer prevention and cancer nursing are broad topics with many interesting facets and complex challenges – from the molecules of drugs to patient interactions. As each patient’s story unfolds, it is easy to see the impact that a cancer diagnosis can have. There is so much to know that cannot be covered in education modules like this, which can only examine small bits of the big picture in the hope that some of it will be useful to the nurse caring for these patients and families. But given the scope of the information for which there is not space, following are some resources that might be of help in inpatient and outpatient settings for the nurse and to share with patients and the people who (almost) never get a day off, caregivers. Resources for nurses Cancer screening, prevention, and treatment information ● ● The National Cancer Institute has cancer information, including PDQs for professionals at http://www.cancer.gov/resources-for/ hp with evidence to support many aspects of cancer, including treatment, palliative care, prevention, genetics, and complementary and alternative treatments. Much more can be found at http://www. NCI.gov or by calling 1-800-4-CANCER. ● ● The American Cancer Society has cancer screening guidelines, complementary and alternative medicine information, carcinogen lists, and information on cancer types and stages, survival, and treatment at http://www.cancer.org or 1-800-ACS-2345. ● ● The National Comprehensive Cancer Network (NCCN) has guidelines for care both for various cancer types and stages as well as supportive care for symptoms like nausea, fatigue, pain, palliative