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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 [14]. Nearly 1.7 million invasive cancers are expected to be diagnosed in the U.S. in 2016 and well over half a million deaths from cancer are expected [14]. 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. will increase steadily over the next few decades [270]. 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 [271]. By 2050, the over-65 group is expected to double in size from 2010 numbers [272]. 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 (i.e. the most recent year for which statistics are available), 6.7% of the U.S. population (i.e. nearly 16 million people) was treated [260]. 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 2005-2011 was nearly 70%. Compare this to just under 50% in 1975-1977 [14]. 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 United States Some cancer types are observed much more often than others, e.g. 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 respectively, although they are slightly more common in men than in women [14]. 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 that has taken place in 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. Note also that 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 [14]. 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 [14]. After these, however, men and women’s cancer incidence and mortality diverge significantly. In men, bladder cancer is the 4th most common cancer diagnosed and melanoma is the 5th most common cancer diagnosed. But, liver cancer and leukemia are the 5th and 6th leading causes of cancer death in men. In women, cancer of the uterus (endometrium) and thyroid are the 4th and 5th most common cancers respectively. But in cancer related mortality in women, ovarian cancer ranks 5th and uterine cancer ranks 6th. Because men do not develop uterine or ovarian cancers due to anatomy, and because these cancers are not as common as breast cancer, these two sex-specific cancers are not represented in rankings for the combined U.S. adult population [14].