Experiences of Breast Cancer Patients with Radiotherapy

Experiences of Breast Cancer Patients with Radiotherapy Introduction and background Breast cancer is the most common cancer among women and leading cause of cancer related deaths of this gender (World Health Organization, 2014). Previously it was most common in developed countries but now it became commonest cancer both in developed and developing regions (Ferlay et al., 2010). Moreover, in USA, breast cancer has the highest incidence rate among all types of cancers involving one in every ten women (Njeh, Saunders, Langton, 2012). However, in Pakistan the incidence is more alarming as 1 in every 9 women is at the risk of developing breast cancer (Siddiqui, n.d.).This data indicates that Pakistan has highest incidence rates of breast cancer in Asian countries (Aziz, Sana, Akram, Saeed, 2004; Bhurgri, et al., 2000; Naeem, 2008). Furthermore, Hussain, Ahmad, Muhammad, Kakakhail and Matiullah (2008) identified the incidence of breast cancer 96.49 % among women registered in Institute of Radiotherapy and Nuclear Medicine, Peshawar, which are more frightening figures. There are certain treatment modalities for breast cancer among them radiation therapy (RT) is an important treatment choice, performed before and after the surgery which also have various side effects. During the course of treatment, about two-thirds of patients undergo radiation therapy, before and after surgery (Guo et al., 2013). In addition, more than 90% of the all breast cancer patients receive adjuvant radiotherapy to prevent the recurrence of the disease (Potthoff et al., 2013). Despite its wide use and significant role in cancer treatment, few studies addressed the experiences of its recipients. According to Welle (1998) radiotherapy patients are perceived as self-caring and their needs are not taken care of. The international literature indicates that breast cancer patient receiving RT not only suffers from disease process but also from the side effect of this treatment. The nature of disease, its prognosis and treatment related problems have devastating effects on physical , psychological and socio-economic wellbeing of the patient (Farooqi Chaudhry, 2012; Kirchheiner et al, 2013). However, these studies have been conducted in western context on different population which has stark difference in our culture. In addition, within the Pakistani context, Khyber Pakhtunkhawa is considered more conservative province. Therefore, it is important to explore experiences and problems of the local population to remedy their problems. Furthermore, data from Pakistan revealed that breast cancer was found mostly in younger age group ranging from 30-50 years as compare to west where it tend to occur in women above 60 years of age (Aziz, Sana, Akram, Saeed, 2004; Mamoon, Sharif, Mushtaq, Khadim, Jamal, 2009; Naeem, et al., 2008; Tfayli, Temraz, Abou Mrad, Shamseddine, 2010). Importantly, this age group is more productive and may have different responsibilities pertinent to their age group towards their family and society which may vary from western population in t erm of their concerns, needs and issues. However, in Pakistan, research in this area is not conducted to explore the experiences of breast cancer patient receiving radiotherapy therefore; research is a required to address the issues of this population. In addition, this is the first study of its nature in Pakistani context especially in Khyber Pakhtunkhwa in the field of nursing which will increase the awareness regarding radiotherapy related problems of patients among nurses and other health care providers. Significance This study is significant to generate information for nurses to care for patient undergoing RT in Pakistani context. It will help nurses to understand the feelings and experiences of the patients undergoing RT to design nursing care plan by addressing their needs. Moreover, findings of this study can help to identify recommendation for health care staff working in the radiotherapy units to facilitate their patients undergoing radiotherapy in a better way. It will also help health care professionals maintain a sense of the importance of the experience of the RT patient who are coming to them for treatment and want their care pertinent to their needs. Purpose The aim of this study is to explore the experiences of the female breast cancer patients undergoing radiotherapy. Study Questions What are the experiences of the of breast cancer patients undergoing radiation therapy in Khyber Pakhtunkhwa, Pakistan? Data sources The review of literature was conducted through data bases CINAHL PubMed, Mosbys Nursing Consult, Science Direct, and Google Scholar. Search for published research articles relevant to this paper was done. The combination of the following key terms was used to retrieve relevant literature â€Å"physical/psychological problems, breast cancer, problems with radiation therapy, quality of life, experiences of breast cancer patients. Search generated 283articles, 52 duplicate results excluded. Through a selection process title and abstract screened, among those 30 were found to be relevant to the topic. Literature review Radiotherapy is one of the essential components of the cancer treatment. It minimizes risk of recurrence, improve survival rate (Bese, et al., 2006). This is done by using high-energy x-rays or gamma rays targeted at the tumor to shrink the tumors or kill cancer cells (Radvansky, Pace, Siddiqui, 2013). During the course of treatment, about two-thirds of patients will undergo radiation therapy, before and after surgery (Guo et al., 2013). Beside this adjuvant radiotherapy is advised after breast conserving surgery as well as after mastectomy to minimize the chances of reoccurrence of the disease. As Darby et al. (2011) found in their meta-analysis study that RT reduced 15-years of risk of breast cancer related death rate after breast conserving surgery. Beside its effectiveness, it exerts multiple physical, psychological and socio-economical problems on patients. Physical problems related to RT Radiation therapy affects cancer as well as normal body cells within the treated area, result in injury of the cells which lead to many side effects. The RT induced side effects include skin and mucous membrane toxicities, sleeplessness, pain, swelling, dyspnea, cough and nausea. (Adams, 2009; Currie Wheat 2006; Darby et al, 201; Gordils-Perez, Duell, 2003; Rose, 2011). In addition, skin problems are the most frequent side effect of RT which affects nearly 85% to 95% of patients and also cause skin damage (Bergstrom, 2011). Additionally, there are many long term side effects of breast irradiation like cosmetic changes hyperpigmentation, fibrosis, lymphedema, and damage to underlying normal structures (Gordils-Perez, Duell, 2003). Moreover, fatigue, soreness and dryness of throat, headache, and desquamation were also common symptom reported by patients receiving RT (Sherminie Cottrel, 2014). Among them fatigue is reported by 80% of the patients receiving RT which affects the role functioning of breast cancer female in their daily life (Poirier, 2011; Potthoff et al., 2013). The RT patent also endure sleep disturbance as Dhruva et al. (2012) reported that approximately 50% breast cancer patients have sleep disturbance at the initiation of radiation therapy. In this connection, a study conducted by Graydon (1994) highlighted that sleep disturbance and fatigues were the main areas of the life of women affected by RT. It influence the physical, cognitive and emotional aspects of the 80% of breast cancer patients underwent RT (Alcantara-Silva, Freitas-Junior, Freitas, Machado, 2013; Stone, Richards, Hern Hardy, 2001). As Currie and Wheat (2006) suggested that it is very important to address and remedy the evident side effect of RT because these are capable of limiting the patient’s ability to tolerate the planned treatment. Psychological problems Breast cancer remarkably affects women’s psychological well-being. One out of two patients with cancer experience psychological disorder (Reyes-Gibby, Anderson, Morrow, Shete Hassan, 2012; Spoletini, et al., 2008). Beside the disease process its treatment modalities also contribute in the psychological problems of the patient. As, Reyes-Gibby et al. (2012) proved that depression among women have positive associated with symptoms of disease and treatment of the breast cancer. In addition, RT is usually prescribed before and after surgery which tend to have its psychological effects on patient. A qualitative study conducted in Sri Lanka to explore the experiences of breast cancer patients undergoing radiation therapy, concluded that women feel fear of treatment, machines used in treatment and blackening of the skin. The study also reported patients feel uncomfortable and stressed in the presence of male staff members and waiting for long time in RT department (Sherminie Cottrel , 2014). In addition, Halkett, Kristjanson, and Lobb (2008) highlighted in their qualitative study, that the patients with breast cancer receiving radiotherapy, experience many kinds of fears like getting burnt, damage to internal body parts, and anticipating tiredness. These kinds of fears may have negative impact on compliance with the treatment regimen. Rose (2011) highlighted that patient feel high level of stress at the start RT because of unfamiliar technology, fear of potential side effects and being in an environment with other cancer patients. A literature review carried out by Lim, Devi, and Ang (2011) concluded that anxiety is predominant psychological issue of the all treatment modalities of the breast cancer across the globe and continue beyond the acute stage of treatment. In relevance to RT it is experienced by10 to 20% of the patients (Stielgelis et al., 2004). Moreover, the fatigue and pain related to RT may affect the sexuality of the patient by decreasing the desi re and arousal and skin changes result in burns affecting body image and self-esteem (Mercadante, Vitrano Catania, 2010). Therefore, the diagnosis and treatment can have a profound influence on a woman’s overall psychological well-being thus compromising the quality of life of the patient. Socio-economical Problems Breast cancer patients face multiple socio-economical problems because the cancer treatment is very expensive which may not be affordable for many of the patients particularly who belong to low income families. A well-established literature signifies that breast cancer patient treated with surgery also receives RT which may be additional financial burden for them especially in the limited resourced countries like Pakistan. Most of the developed countries of the world, large part of expenditure of the cancer treatment are paid by the government, but in Pakistan, the costs of the therapy are borne by the patient and their families (Zaidi, Ansari, Khan, 2012). Many breast cancer patients in Pakistan experience finical difficulties and use their savings to pay for treatment (Banning, Hassan, Faisal, Hafeez, 2010). Moreover, statistics also highlights that the incidence of breast cancer is increasing in countries with inadequate resources thus limiting the access to radiotherapy (Bese, 2006). Due to finical barriers, Pakistani female breast cancer patients face different challenges throughout the course of the disease (Ahmed, Shaikh, Hasan, 1997). Apart from economical issue woman with breast cancer faces many social and cultural problems in Pakistan. A qualitative study by Banning, Hassan, Faisal, and Hafeez (2010) reported that in Pakistani culture breast is considered a hidden organ that should not be exposed, discussed or touched by others. They also highlighted that most of their participants reported stigma attached to a diagnosis and likelihood surgery therefore they hide their diagnosis from family and local community. Furthermore, in conservative culture of developing countries female are less empowered and given low priority and their health issues are least bothered by the society (Tfayli, Temraz, AbouMrad, Shamseddine, 2010). In this regard, female with breast cancer may experience unbearable problems which may not be experienced by women of differen t cultural and social class (Aziz, Sana, Akram, Saeed, 2004). Knowledge of Treatment The above mentioned literature suggests that patients receiving RT face significant challenges and require appropriate information regarding their treatments, side effects of treatment and coping strategies allows them to feel more control over disease and its related problems. Such as, Halkett et al. (2012) emphasized that undergoing RT is difficult experience for patients which needs appropriate and specific information to have the better outcomes of the therapy. Though, the RT is an important treatment but their patients are found to be poorly informed (Halkett, Kristjanson, Lobb, 2008; Sherminie Cottrell, 2014). This may contribute in their fear, anxiety, stress, and compliance with treatment. Thus the appropriate information and guidance help the patient to make better choices of treatment modalities (Barnett et al., 2004). In addition, findings of a quantitative study by Zeguers et al. (2012) showed that RT patients want comprehensive information about their disease, treatmen t, and procedures, side effects, and prognosis with the mean scores between 4.1 and 4.4 on a scale from 1 to 5. In contrast, Barnett et al. (2004) emphasized that information needs vary among different individual therefore, a patient-centered approach must involve according to the tolerance and need of the patient. A randomized trial study conducted by Christman and Cain (2004) also concluded that patients receiving concrete objective information reported maintaining higher levels of usual function than those not receiving. Furthermore, giving information about symptom experiences helped them to mentally tackle uncertainty about their symptom experiences. Gap analysis The incidence of the breast cancer continues to rise worldwide. Multiple treatment modalities have positive impacts on prognosis of the cancer. Radiotherapy is one of the commonly used treatment modalities having its side effect as well. Moreover, available literature suggest that a series of problems faced by patients receiving RT. But, there is a profound need to develop clear understanding of the phenomenon that what patients experience when they undergo RT. Moreover, nursing literature needs to address the needs of these patients and recommend evidence based interventions to help them. Furthermore, in the context of Pakistani conservative culture women with breast cancer may be experiencing different problems than western women. Therefore, this study question needs a qualitative study to arrive at the desired outcome of better understanding of the situation.

Basic Principles Of Democracy :: essays research papers

The United States of America has five basic principles which ensure the ability of the country. The basic foundations: fundamental worth, equality of all persons, majority rule minority rights, necessity of compromise, and ividual freedom. This paper reviews three of the five principles: majority rule and minority rights, individual freedom, and necessity of compromise. Two of these cases of individual freedom plus majority rule and minority rights the United States has failed to uphold. The third case on individual freedom is an undecided case at this point. The United States must not ignore these ations’ importance making judicial decision or the stability of the country is at risk.   Ã‚  Ã‚  Ã‚  Ã‚  Majority rule and minority rights is a basic foundation of democracy. A general concept of this foundation is that the popular vote will be the deciding party in most cases. Along with this concept the minority of the people will maintain certain basic human rights that will not be compromised by the popular vote. A challenge to this principle occurred when Asheville City district zoning was voted on many years ago, and unfortunately was passed. The rules and restrictions that are accompanied by zoning are phenomenal. In many cases the taxes rise depending on how property is zoned. For example, if property is zoned as commercial property the taxes are considerably higher than if property was in a residential area. Consequently the minority here is being punished. More permits must be acquired and plans must be approved before anything can be done to ones own land. Zoning was voted in by the majority, however the minority’s rights were not completely maintained. People need to maintain certain basic rights, and these rights pertain to what they may do to their property. Justification of how the government failed to honor this basic foundation.   Ã‚  Ã‚  Ã‚  Ã‚  Individual freedom is by far one of the most important foundations to a democracy’s survival. Individual freedom is difficult to define, though a general meaning is illustrated by a quote from Oliver Wendell Holmes, â€Å"The right to swing my fist ends where another man’s nose begins.† Enforcing people to wear their seat belt against their will is an example of how America has failed to secure the one of most important foundation of democracy. People should have the right to choose whether or not they wear their seat belt. The American government and the North Carolina government specifically passed a law which makes all passengers in the front seat, no matter what age, wear their safety belts.

Interactive Writing Essay

Animated productions and video games offer customers a world to get lost in. In this world, creative writing plays an integral role producing an atmosphere that progresses and sustains fluidity. Although graphics and user controls are typically the talk of animated production writing is just as significant. Without creative writing these worlds of animation might be a little bleaker and less interactive. Graphics would have no bearings if they did not have a background of description to be created from. Game and Production writers play a crucial role in the development of the media. Video games usually have paths to follow, and offering misdirection, speed bumps and challenges to overcome. It takes a large amount of skill to transfer ideas into a media, and that is where developers come in, but if they do not have a game plan to follow a mess can occur. Writers are becoming increasingly more involved in the video game and animated production business. In order to efficiently supply these elements a production has to be planned out or time lined. In this time line, it takes writer’s input to create a structured story which is critical for the flow of the game and the story being portrayed. A well developed story or plot can draw in players to purchase the media and any games that might follow. One writers expresses why a well written video game is more than important, â€Å"As gamers age, the complexity of both the plot and the theatric elements tend to resemble short skits along the lines of â€Å"Godfather,† leaving the days of Super Mario Brothers long lost in the dust† (Brewer, 2002). Writers are essential in creating a world beyond any gamers’ imagination. Typically animated productions or video games are stemmed from a developer’s idea, but it is the writing that carries the developer’s initial thought. It is up to writers to be very descriptive. After the story board and character development it is up to an interactive writer to begin on a script. The script can make or break a game’s potential. A productions script must be carefully combed using effective words that will spark user’s imaginations as well as guide them easily through the set path. A writer must be very descriptive in their script leaving little discrepancy over the visual settings. Also, the game’s story will need to be broken into parts in order to have levels or sense of accomplishment for the user. A article suggests,  Ã¢â‚¬Å"There are three main points to the written script: describe the environment; what does everything look like -and what does it feel like, what is the accompanying material, is there music, and sound effects , what are the things that are going to happen, what decisions will be made, and what rooms or areas are the decisions tied to† (Kalif, 2008)?It is the writer’s job to create substance. If a game is not well put together and has only one path to the end of the media, then it is less likely to be played again. When productions set on a buyer’s shelf it means they are less likely to buy the game when a new version is created. Video game companies now spend sufficient money to hire creative writers. If a gaming company is known for their extraordinary atmospheres, settings, and characters, users are more likely to try games from the company without much knowledge of the particular game. These writers become so involved in their stories, they create more opportunities to make a game company more money with the ability to produce other games, movies, action figures. A video game writer said in an interview, â€Å"I fall in love with every game story that I work on, enough so that I can envision countless stories, sequels, movies, and books all emanating from within this one world† (Duffy, 2007). Animated production and video game writers are essential in the development process. These productions have progressed significantly over the past ten years and a lot of the progression can be accredited to the ever more use of writers. As we have seen, writers take an idea and form it into something more tangible that users can relate to and are drawn to in order to continually play a game. A creative writer can serve in many roles and typically do not get as much credit as the producers or developers, but it is these unsung heroes that provide the developers with an atmosphere and a descriptive setting for their characters. Old games like â€Å"Pacman† are fun and can be entertaining, but it is the new games like â€Å"Grand Theft Auto† that drive the industry even more toward creative and efficient writing. References Brewer, Melissa, (2002). Writing for the Gaming Industry. Retrieved on December 15, 2008 from http://www.writing-world.com/freelance/games.shtmlKalif, Will (2008). Writing a Script for a Video Game. Retrieved on December 19, 2008 from http://www.stormthecastle.com/video-game-design/writing-a-video-game-script.htm. Duffy, Jill, (2007). How I Became a Game Writer. Retrieved on December 19, 2008 from http://www.gamecareerguide.com/features/424/how_i_became_a_game_writer_an_.php?page=4.

Theories of Revolution - 2542 Words

Theories of Revolution What is a structural theory of revolution? How does a structural theory differ from explanations that emphasize the role of individuals, ideology, and culture? Assess the strengths and weaknesses of these approaches for understanding the origins and outcomes of revolutions. Theories of revolutions come from many sources and involve informed decisions made by the reader. In order for one to come to the final realisation as to what the theories of revolutions are one must first answer the following questions: what is a structural theory of revolution? How does a structural theory differ from explanations that emphasize the role of individuals, ideology and culture? It also involves the strengths and†¦show more content†¦The role of individuals in this case fails to differ from the lack of respect and poor treatment shown to peasants, which was explained in the definition of the structural theory. Thus, one must move onto the next point – how does the role of ideology differ from the structural theory of revolutions? Ideology appears to play an important role in a revolution. This is especially the case for new leaders which are trying to gain the support of both the peasantry and the elite class. In order for a new leader, or polity, to gain any support, they must first begin by having a campaign plan and create aims which they are determined to receive in order to gain power and lead any revolution. In order to do this, a potential leader must primarily prove to be somewhat â€Å"charismatic†. This would preferably be a person who considers themselves to be capable of challenging the traditional authorities, accumulate supporters and potentially be capable of eradicating the old regime: â€Å"....a â€Å"charismatic† leader...challenges traditional authorities, gathers followers, and leads the overthrow of the old regime†.[6] It is quite obvious that unless many enticing ideas are presented properly to the people of a country preparing to revolt, then there would be no revolution. However, one must consider the ideas which are being presented to the public. 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