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Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation. Introduction Nurses who work in inpatient or outpatient settings with adult cancer patients face a wide array of challenges. Oncology treatment is a rapidly changing field with an ever-expanding body of knowledge and compelling opportunities. After a patient is diagnosed with cancer, nurses perform comprehensive assessments to identify potential issues that can affect treatment as well as help the patient identify problem areas and pinpoint major concerns. Nurses are positioned to assist in addressing the needs for information, interventions, and referrals as well as offering other helpful measures. Nurses are tasked to help patients understand complex medical regimens, consider options, and make decisions that are suitable for them and their situations. All of this demands a commitment to seek out current information, find and evaluate standards of practice, and adopt the best approaches to patient care. THE BURDEN OF CANCER Cancer is the second leading cause of death in the United States (U.S.) The estimated lifetime risk of developing an invasive cancer in the U.S. is 42% in men and 38% in women, which means that almost one out of two men and roughly one out of three women will develop cancer during their lifetimes. This risk is lower early in life and increases with age; about 86% of all cancers are diagnosed in people aged 50 years or older. Fortunately, many cancers are preventable. Cancer affects all races and ethnicities. Cancer incidence is rising, and the trend is expected to continue as the number of people 65 and older in the U.S. increases steadily over the next few decades. According to the U.S. Administration on Aging, the proportion of people 65 and older will climb from 14.5% of the total population in 2015 to 19.7% by 2030. By 2050, the over 65 group is expected to double in size from 2010 numbers. The number of adults being treated each year for cancer is increasing. According to the Agency for Health Care Research and Quality Medical Expenditure Panel Survey program, 4.8% of the U.S. adult population was treated for cancer in 2001. In 2011 (the most recent year for which statistics are available), 6.7% of the U.S. population (nearly 16 million people) was treated. The American Cancer Society reports that the invasive cancer survival rate has improved over the past 40 years. Although survival varies markedly by cancer type and stage, the five-year relative survival rate for all cancers during from 2005 to 2011 was nearly 70%. Compare this to just under 50% in between 1975 and 1977. Survival is not the same as cure, a term that is much harder to define and almost impossible to measure; however, the improved survival rate reflects quite a lot of progress in both improved treatment and earlier detection. Incidence of common cancers in the U.S. Some cancer types are observed much more often than others, for example, breast and prostate cancers. One in eight women will be diagnosed with breast cancer during her lifetime, and one in seven men will be diagnosed with prostate cancer. Lung cancer and colon cancer are the second and third most common types of invasive cancer in both men and women although they are slightly more common in men than in women. (See Table 1.) Table 1. Estimated numbers of cases and deaths for common cancers in the U.S., 2016. Cancer type New cases expected in 2016 Expected deaths in 2016 Breast cancers (women and men). 246,6000 + 2,600 40,450 + 440 Cancers of the lung and bronchus. 224,390 158,080 Prostate cancers. 180,890 26,120 Colon and rectal cancers. 134,490 49,190 Bladder cancers. 76,960 16,390 Melanomas. 76,380 10,130 Non-Hodgkin lymphoma. 72,580 20,150 Thyroid cancers. 64,300 1,980 Renal cell and renal pelvis cancers. 62,700 14,240 Leukemias (all types). 60,140 24,400 Endometrial cancers. 60,050 10,470 Pancreatic cancers. 53,070 41,780 Excerpted from American Cancer Society: Cancer Facts and Figures 2016. Differences between incidence and cancer deaths Despite being the second most common cancer diagnosed, lung cancer is the number one cause of death for both men and women. The good news is that lung cancer deaths in the U.S. peaked in the beginning of the 21st century and are now on a slow decline. The lung cancer mortality curve correlates to the decline in smoking over the past few decades. Colon cancer is the fourth most commonly diagnosed cancer, but it is the second overall cause of cancer mortality in both men and women. Pancreatic cancer, despite being 12th in incidence, is the third most common cause of cancer mortality. Breast cancer and prostate cancer round out the top five. Comparing cancer incidence and causes of mortality by sex If the U.S. population is divided by sex, lung cancer is still the number one cause of cancer death, but prostate cancer rises to the second cause of cancer death in men, and breast cancer becomes the second leading cause of cancer death for women. Colon and rectal cancer drop to third and pancreatic cancer becomes fourth for both men and women.