The experience of discrimination
Order Description
Imagine you are in heaven and the angel in front of you says: You are going to be born to the world. In America. But guess what? We give you choices. There are some groups in America that are in disadvantaged positions for example Blacks. So you can choose to be born White or you can choose to be born Black with cash compensation. The cash will be deposited to your bank account when you are born.
Question: If you choose to be born Black in America how much compensation do you think is reasonable? The more specific the better.
Chapter 11
*
The Experience of
Discrimination
Oh is there still racism?
-ANONYMOUS STUDENT ON HEARING THAT A COURSE
ON RACISM WAS BEING OFFERED ON HER CAMPUS
QUOTED IN TATUM (1997 P. 3)
I dont think White people generally undmtand the
full meaning of racist discriminatory behaviors directed
toward Americans of African descent. They seen1 to see
each act of discrimination or any act of violence as an
isolated event. As a result most White Americans cannot
understand the strong reaction n1anifested by Blacks when such
events occur. They feel that Blacks tend to overreact. They
forget that in most cases we live lives of quiet desperation
generated by a litany of daily large and small events that
whether or not by design remind us of our place
in American society.
-ANONYMOUS BLACK PROFESSOR QUOTED IN FEAGIN
AND SIKES (1994 PP. 23-24 EMPHASIS IN ORIGINAL)
Chapter Outline
Social Stigma
What Defines a Stigmatized
Group?
Stigma by Association
Tokenism
418
Responses to Prejudice and
Discrimination
Attributional Ambiguity
personaJ/Group Discrimination
Discrepancy
Consequences of Prejudice to the
Target
Stereotype Threat
Vulnerability to Stress
Threats to Self-Esteem
Coping with Discrimination
Psychological Disengagement and
Disidentification
THE EXPERIENCE OF DISCRIMINATION 419
Behavioral Compensation
Summary
Suggested Readings
Key Terms
Questions for Review and Discussion
As we saw in Chapter 6 many White Americans think prejudice is more or
less a thing of the past. It is certainly true that more blatant fonlLS of prejudice
have declined in the United States because of both legislative and social changes.
It is also true however that the existence of prejudice and discrimination can simply
be iuvisible to many members of the majority group. It is sometiules difficult
for the majority group to accept that for many people prejudice and discrimination
are a lived experience (Feagin & Sikes 1994 p. 15) and are not inconsequential
beliefs and actions that can siulply be overlooked while getting on with
ones life. Instead for members of stereotyped groups these experiences are
woven iuto the fabric of their lives. Much of this book has focused on theories about
and research on prejudiced people. In this chapter we tell the story of prejudice and
discrimination from the poiut of view of those lived experiences focusiug on the social
psychological research that describes and explains them.
As we have seen in earlier chapters prejudice and discrimination can take
many fonns depending on the actor the situation and the historical time period
in which a person lives. These factors similarly affect those who experience prejudice
creating a dynamic interchange between those who treat others unfairly and
those who are the recipients of this injustice (Dovidio Major & Crocker 2000).
This chapter focuses on the consequences of this exchange as they affect every
aspect of the stigmatized persons life including their academic and economic
achievement and their physical and mental well-beiug.
SOCIAL STIGMA
To fully understand what it is like to experience discrimination it is important to
know what factors set others apart from the dominant group increasing the likelihood
that they will be discriminated against. Recall from Chapter 1 our discussion
of group privilege. This privilege is defined as membership in the dominant
group a status that is seen as nonnal and natural and is usually taken for granted
(A. Johnson 2006). Dominant group membership is sometimes referred to as
majority group membership but this is somewhat of a misnomer. Privileged status
often comes from being in the majority; however it is not defined simply by
420 CHAPTER 11
a groups numerical advantage. For example the British rule of India lasted more
than 300 years; during that time Indians faced severe racial discrimination from the
British even though the Indians greatly outnumbered the British (Dirks 2001)
Similarly although Blacks in South Africa outnumber Whites four to one until
1994 Blacks were subjected to apartheid laws that enforced their segregation
from Whites governed their social life and limited their employment options
(Beck 2000) The vestiges of apartheid continue to affect Blacks in South Africa.
Privileged status then is defined less by a groups numbers and more by its power
and influence. We begin our discussion by outlining the factors that delineate a
groups privileged or disadvantaged status.
What Defines a Stigmatized Group?
~Whether they are consciously aware of it or not individuals with privileged status
define which groups do or do not share this status. In social psychological tenns
those groups that do not share this status are stigmatized or deviant. Stigmatized
-groups differ from the privileged or dominant groups in terms of appearance or
behavior. Members of stigmatized groups violate the nOn11.S established by the
dominant group on these dimensions and as such are lllarked by the resulting
social stigma (Jones et al. 1984). Because of this members of stigmatized groups
are sometimes referred to as the marked and those who are the actors or the ones
who stigmatize are sometimes referred to as the markers. Marked individuals are
devalued spoiled or flawed in the eyes of others (Crocker Major & Steele
1998 p. 504). The consequences of this devaluation are fur reaching and can include
dehumanization threat aversion and other negative treatment including
subtle forms of discrimination (Dovidio et al. 2000).
Which groups are stigmatized by the privileged or dominant group? The
answer depends on the culture and on the historical events that led to the current
cultural context. As we saw in Chapter 1 for example the Irish and Italians were
once considered non~White and were targets of discrimination in the United
States; today they are accepted as part of the White majority (Rubin 1998).
Returning to our earlier examples India is now governed by its own people and
is not subject to British dominance and Blacks in South Africa have made significant
strides toward undoing the effects of apartheid. Hence historical events and
changes in laws and social nonns affect cultural beliefS about who can or should be
stigmatized even if it sometimes takes many years to see their effects. More generally
dominant group members detennine which individuals are stigmatized based
on any number of characteristics including membership in an underrepresented
basic social category such as ethnicity or old age or in a socially deviant category
defined by physical or mental disability weight socioeconomic status or sexual
orientation. People also can be stigmatized because of their acne their mothers alcoholism
a speech impediment or illness among many other things (Jones et al.
1984). To be stigmatized then individuals must have a characteristic that is devalued
by the dominant group and that sets them apart from that group. Regardless of the
source of the stigma in all cases there is shame associated with being nurked
(Goffinan 1963).
THE EXPERIENCE OF DISCRIMINATION 421
As you read this list of stigmatized groups you might have concluded that
almost everyone has had the experience of being different from the majority and
has suffered because of it. It is true that being different from the group is often part
of normal human life. If you have had such experiences it may give you some
insight into what it is like to be a member of a stigmatized group. But for majority
group members nlany times these experiences are short-lived or othenvise benign.
Benign stigmas such as acne a correctable speech impediment or a short-tenn illness
differ in important ways from the more harmful stigmas social scientists most
often study such as those based on ethnicity severe mental illness or sexual orientation.
Because these latter stigmas typically have more negative consequences
ranging from depression to extreme violence against the stigmatized group they
are the focus of this chapter. Edward Jones and his colleagues (1984) have identiJ
fied five dimensions that are particularly helpful in differentiating between harmful
and benign stigmas: course concealability aesthetic qualities origin and peril.
1.
2.
Course. Benign stigmas are often temporary; that is the course of the stigmal
is short. For example acne is usually outgrown or can be cured by a J
dennatologist. In contrast the course of many negative stigmas cannot be -J
changed. An individua1s ethnicity is typically part of his or her lifelong
identity for example. Another tenn that is sometimes used is stability; some
stigmas are perceived to be stable or pennanent whereas others are
perceived to be unstable and so can change over time. In general people
believe that physica11y based stigmas such as blindness or cancer are stable
and that mental-behavioral stigmas such as drug abuse or obesity are
unstable (Weiner Perry & Magnusson 1988). In general stable stigmas
have more negative consequences for the stigmatized person.
Concealability. Some stigmas are concealable which means they can be I
hidden or controlled by the stigmatized person. Such stigmas can be avoided J
simply by keeping the stigma private such as by not ta1king about ones
alcoholic mother or can be hidden such as by wearing makeup to cover a
scar or birthmark. Moreover some individuals can and do choose to pass
for a member of a different ethnic group thus concealing their group
membership. However as John Pachankis (2007) explains concea1ing a
stigma does not reduce the guilt and shame associated with that stigma.
Moreover the need to continuously monitor behavior so that the stigma
remains undisclosed can be anxiety provoking. fu he notes [i]n every new
situation that is encountered such individuals must decide who among the
present company knows of their stigma who may suspect this stigma and
who has no suspicion of the stigma (p. 328). Many gay men and lesbians
for example are not open about their relationships out of fear of social
rejection loss of employment or the threat of physical violence; as a result
they often find themselves lying about or hiding an important part of their
life and they feel guilt and shame because they must do so (Meyer 2003).
Similarly people often fail to seek treatment for menta1 illness because of the
stigma associated with revealing their problem (Corrigan 2004). People who
have stigmas that cannot be concealed have a different set of problems; they
422 CHAPTER 11
3.
~.
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Get Help Now!realize their membership in a stigmatized group is apparent and this in tum
affects their thoughts feelings and behavior. They must always directly
cope with the prejudice and discrimination associated with their group
membership (Crocker et al. 1998).
Aesthetic qualities. Aesthetics refers to what is beautiful or appealing.
As we discussed in Chapter 3 many stereotypes are triggered by physical
appearance cues (Fiske & Taylor 1991) and many stigmas are based on
this dimension as well. In general less physically attractive people are more
likely to be stigmatized (Eagly Ashmore Makhijani & Longo 1991). One
reliable indicator of physical attractiveness is facial symnletty or the degree
to which the left and right sides of the face are mirror images of each
other (Langlois & Roggman 1990). Inclividuals with facial disfigurement
typically do not meet this standard and are likely to be stigmatized. In North
American culture slimness is emphasized and overweight people become
the targets of cliscrimination (Crandall et al. 2001). Similarly a central
component of the old-age stereotype is a decline in physical attractiveness
and mobility (Slotterback & Saarnio 1996).
Origin. This tenn refers to how the stigma came to be and whether its
onset was under the control of the stigmatized individual. Stigmas perceived
to be controllable include drug addiction acquisition of HIV and obesity;
those perceived to be uncontrollable include cancer and heart disease
(Weiner et al. 1988). Physical characteristics that one is born with such as
race or many disabilities also are perceived to be uncontrollable Gones et al.
1984). Peoples beliefs about the controllability of a stigma have important
implications for acceptance of the stigmatized other. When people believe
that a stigma is uncontrollable they feel nlore pity and less anger toward
the stigmatized individual compared with when the stigma is perceived
as controllable (Dijker & Koomen 2003; Weiner et al. 1988). This
viewpoint is evident in this excerpt from a letter to the editor that appeared
in the Chronicle Review: Race is something that a person has no control
over; hence racism is wrong. Homosexuality is a choice a person makes
and therefore it is not wrong to disagree with it (Colvin 2003 p. B4).
Research suggests that others share Colvins viewpoint. For example
Bernard Whitley (1990) found that people who believed that sexual
orientation was controllable had more negative attitudes toward lesbians
and gay men than did people who believed sexual orientation was not
controllable.
Peril. Members of some stigmatized groups are perceived correctly or
incorrectly to be dangerous. Persons with a mental illness for example are
stereo typically perceived to be dangerous even though statistically they are
no more likely to commit violent crime than people not so diagnosed
(Corrigan & Penn 1999). As we saw in Chapter 3 people stereotypically
assume that Blacks are more dangerous than Whites (Duncan 1976).
Especially in the early years of the AIDS epidemic the stigma associated
with HIV infection was found to be related to the belief that persons with
THE EXPERIENCE OF DISCRIMINATION 423
AIDS were highly contagious and therefore dangerous (Triplet & Sugannan
1987). In general groups assumed to be more dangerous are more stigmatized
than groups perceived as less dangerous (Jones et al. 1984).
Stigma by Association
So far we have discussed what sets individuals apart from the dominant group.
One underlying assumption is that the dominant group generally rejects members
of stigmatized groups. But what happens when a member of the majority
group associates with a stigmatized person? Erving Goflinan (1963) proposed
that such an association would result in a courtesy stignla whereby the nlajority
group member would also then be stigmatized. In the past mainly anecdotal
data supported this possibility. However recent research suggests that Goffinans
hypothesis was correct. For example Steven Neuberg and his colleagues (Neuberg
Smith Hoffman & Russell 1994) asked male research participants to watch a
social interaction that they believed was between either two friends or two
strangers. In the course of the conversation one of the men (Person A) discussed
his relationship as being with either a woman or a man which also revealed that
he was either heterosexual or gay. Person B the other man was presented as
heterosexual. Results supported Goffmans hypothesis: there was a courtesy
stigma or a stigma by association with the gay man. That is male research participants
were less comfortable with Person B when they believed he was a friend
of rather than a stranger to the gay Person A. When Person A was described as
heterosexual Person Bs evaluations did not depend on how well he knew
Person A. Janet Swim and her colleagues (Swim Ferguson & Hyers 1999)
also found that people fear stigma by association with gay people. In their study
heterosexual women behaved in ways that socially distanced themselves from a
lesbian even when doing so required agreeing with socially unpopular positions
or making sexist responses.
Additional research suggests that simply interacting with an obese person can
produce a courtesy stigma. Research participants were less likely to recommend
hiring a job applicant who was shown interacting with an overweight person at a
social gathering regardless of how well tbe applicant knew the overweight person
(Hebl & Mannix 2003). Similarly children as young as 5 years old dislike
girls more when they are pictured next to an overweight rather than an average
weight child. However this courtesy stigma did not emerge for boys who were
pictured with an overweight boy (Penny & Haddock 2007). Finally individuals
who are dating a person with a disability are subject to stigma by association
including the perception that they are less intelligent and sociable than those
dating a nondisabled person (Goldstein & Johnson 1997). Yet some aspects of
this stigma by association were positive including the perception that those dating
the disabled were more nurturant and trustworthy than those not doing so.
Even so these positive perceptions are consistent with the idea that those associated
with stigmatized others are different. As the authors note even respondents
positive comments focused on this difference pointing out for example how
424 CHAPTER 11
much a person had to give up to date someone with a disability. In DUllY cases
the comnlents indicated sympathy for the nondisabled person. Taken together
these studies suggest that Goffinans idea has merit; there are social consequences
for associating with a deviant.
Tokenism
We noted above that being a numerical minority is not in and of itself sufficient
to produce stigmatized status. That is power and status are important cOlnponents
of defining privilege and nonprivilege. This does not mean however
that being in the minority produces no negative effects particularly in certain
situations or settings. That is one can be in the majority or near majority in a
larger population but still have stigmatizing experiences from being a minority
within a particular context. Women for example are now represented in the
labor force at numbers nearly equal to men. Many however still have negative
experiences that result from being in the minority in some environments such as
[
being the only woman in a particular work group (Yoder 2002). When individuals
are a statistical minority within a particular setting they can be treated as
tokens and can be stigmatized because of it. In general token status occurs when
there is a preponderance of one group over another such as when one gender or
ethnicity is in the majority and only a few individuals fronl another gender
or ethnicity are represented (Kanter 1977).
Rosabeth Moss Kanter (1977) pioneered the research on tokenism in her case
-stUdY of a multinational Fortune 500 corporation. Kanter highlighted three perceptual
tendencies that affected the daily lives of tokens: visibility contrast and
assimilation. Visibility refers to the tendency for tokens to get attention or as she
put it capture a larger awareness share (p. 210). Consider for example this vi-
sual field containing a series of 9 XS and ouly 1 0:
XXXXXXXOXX
Notice that your eyes tend to be drawn toward the 0 and not to any individual
X. As we saw in Chapter 3 the perceptual process is similar in social situations;
peoples attention also tends to be drawn to the novel or unique person
rather than to members of the majority group (Fiske & Taylor 1991). Members
of the minority or token group are slll1ply noticed more than are other group
[.
members. Contrast refers to the polarization or exaggeration of differences between
the token and the dominant group. A White person in a group conlprised
. only of Whites for example might not think much about her or his racial identity.
The presence of a Black person however brings race to the forefront raising awareness
of race for members of the dominant group. Similarly adding a woman to an
all-male work group can raise awareness of gender issues. Often both dominant and
[
Oken group members are uncomfortable when this happens. Assimilation occurs
when the token is stereotyped; in particular the tokens characteristics are distorted
so that she or he fits the expected stereotype. A group of men then notice when a
-token woman behaves in a way that confinns their stereotypes about women and
THE EXPERIENCE OF DISCRIMINATION 425
often generalize from that confinnation. However the same men tend not to notice
when the womans behavior does not confonn to their gender stereotypes.
These perceptual tendencies have important consequences for the token
which Kanter (1977) illustrated with examples from her case study. She found
for example that whenever token women did something unusual it stood out.
As she describes it [t]hey were the subject of conversation questioning gossip
and careful scrutiny Their names came up at meetings and they would easily
be used as examples [S]01ne women were even told by their managers that
they were watched more closely than the men (p. 212). This was a doubleedged
sword; their achievements were noticed but so were their mistakes.
And their actions were seen as representative of a11 women not just of
themselves as individuals. Consequently evel1 small decisions such as what to
wear to a business meeting became important. Most people find such situations
difficult to navigate as the additional examples provided in Box 11.1 illustrate.
Tokens often feel isolated but at the same time must go on as if the differences
do not exist and do not affect their work. Solos or people who are the only
minority member in a majority group often feel alone and without support
(Benokraitis & Feagin 1995). As one Black woman wrote the responsibility
associated with being the ouly Black female in my college and only one of a
handful in the university was overwhelming. I have suffered several instances of
burn-out and exhaustion. & a consequence I have learned to maintain a less
visible profile as a coping and survival strategy (Moses 1989 p. 15). All told
the negative effects of being in the minority can create what has been ca11ed the
chilly climate (Sandler & Hail 1986). Tokens do not feel welcome or supported
in their environment and often their work and personal lives suffer
because of it.
Although Kanter (1977) defined token status as simply being in the numerical
minority more recent work suggests numbers alone do not define token
status. For example women who pursue nontraditional occupations are more likely
to experience the effects of tokenism than are women in traditional occupations
(Yoder 2002). A survey of undergraduates for exanlple found that women in
male-dominated academic areas such as math science and engineering reported
higher levels of current sex discrimination than did women in female-dominated
academic areas such as the arts education and social science (see Figure 11.1;
J. Steele James & Barnett 2002). However mens perceptions of current sex discrimination
were not affected by their area of study. This pattern also emerged in a
measure of whether sex discrimination was expected in the future; women in maledominated
professions were most likely to hold this expectation and were most
likely to consider changing their major. As we discussed in Chapter 10 men in
female-dominated occupations such as nursing and social work rarely have the
same negative experiences as women in male-dominated professions and may even
be on the fast track to promotion (Maume 1999; WillianlS 1992) although there
may be exceptions in some settings. For example Susan Murray (1997) found that
male child-care workers were pushed away from performing tasks that requITe
nurturing and received the clear message that child care was womens work. These
426 CHAPTER 11
What does happen to the deviate? The deviate
can convert but short of a sex change operation
a time machine to age me and a personality
overhaul conversion seems out of the question
for me. Be isolated? That originally was all right
with me but that surely does not make me a team
member. What can I do? Yet the failure is placed
squarely on my shoulders. What is wrong with
you? Why cant you get along? These
questions haunt me undermining my self-image.
-JAN YODER (1985 p. 67)
It is difficult to document exactly what form a tokens
negative experiences might take. That is the actual
events that comprise those experiences are very
personalized. Moreover many of the individual instances
that lead to the isolation and loneliness experienced by
tokens seem harmless on the surface especially to those
who are not directly living with them. As you read the
personal accounts described in this chapter they too may
seem harmless. Keep in mind however that the research
evidence suggests that over time such experiences
affect those in token roles by isolating them from the
dominant group lowering their self-esteem and creating
loneliness (Sue et aI. 2007). As a respondent in Paula
Caplans (1994) survey of women in academe described
their cumulative impact is similar to lifting a ton of
feathers (p. 9). Over time their weight IS unbearable.
This weight is illustrated by the opening quote in
this box which came from Jan Yoders (1985) first
person account of being the first female civilian faculty
member at a United States military academy. Her
writings captured her dilemma about howto respond to
her interactions with the military officers who comprised
97 percent of the faculty. As she notes in her account
no one event seemed overly traumatic. Yet because of
their cumulative impact she stayed only six months.
Here are a few of her experiences:
Because she openly questioned the sexism of
some exam questions she was given a suggestion book
so she could quietly record her objections without
disrupting faculty meetings.
Her department chose to use Macho Man as its
theme song a song few women would choose to
represent themselves.
Gossip about her ranged from shes a lesbian to
she is heterosexual but promiscuous.
Despite her efforts to clarify her position in the
academy at social gatherings it was widely assumed
that she was the wife of one of the officers.
..
. . . :
. .. .. .
Bernard K. Kardos September 18, 2017
Oncology/Cancer palliative treatment Order Description to provide work similar t
Oncology/Cancer palliative treatment
Order Description
to provide work similar to the attached document plagiarism need to be checked before final submission please.
Title: Cancer palliative treatment
1- What do you understand by palliate cancer treatment (50%).
2- Give examples of what treatment modality can be used for palliation (30%).
3- Give one example of a cancer where palliative treatment is used (20%)
The World Health Organisation defines (WHO) cancer as the major cause of death globally and estimates that 7.6 million people died of cancer in 2005. (1) Another estimate in the United States shows that by 2030 almost 20% of their population will be 65 years of age and older including those with cancer who will require comprehensive health assessment and symptoms management without compromising their quality of life. (2)
Palliative cancer treatment and care is one of the four basic components of cancer control effective programmes implemented by the WHO to reduce the cancer morbidity mortality rate and improve the quality of life in cancer patients.
Palliative care is defined by the WHO as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical psychosocial and spiritual (3).
There are two aspects in cancer palliation; palliative treatment and palliative care. (45)
(A) Palliative Cancer Treatment:
The aim of palliative cancer treatment is to improve the quality of life by relieving symptoms caused by cancer illness or side effects of cancer treatments and to prolong number of living years even in non-curable cases. (46) The treatment can be introduced at any stage during an illness to relief symptoms of sickness or pain such as Dexamethasone in Moderate Emetic Chemotherapy (7) and Opioids in treating cancer pain (8). In addition palliative treatment can also be used in treating symptoms for example reducing the size of tumour mass by localised radiotherapy or surgery to relief pressure symptoms (4).
Palliative Cancer Treatments include the following:
Palliative Chemotherapy:
Is the treatment with cytotoxic drugs to kill tumour cells can be administered intravenously (IV) intramuscularly orally or topically in some cases of skin cancer. Mainly the IV route of administration is associated with severe side effects while given in cycles followed by recovery period. Due to the aggressive blood cells destruction by cytotoxic drugs and rapid cell division of digestive tract patient may develop signs of infections bleeding nausea and vomiting hair loss or mouth ulcers. These symptoms are treated by prescribed medicines and tend to gradually ease during the recovery period or after the treatment is complete. Bone marrow transplantation and peripheral cell support to replace cell production could be considered in some cases following chemotherapy and/or radiotherapy. (9)
In many cases where chemotherapy is the curative therapy patients are willing to accept the treatment side effects and compromise their quality of life in order to be cured. Examples of cancers cured by chemotherapy are: stage IV testicular cancer early stage breast cancer and colon cancers Hodgkins Disease acute leukaemia and localised cervical cancer (10). However the same strategy applies when the goal is palliative for example in cases like advanced breast cancer and colon cancers lung cancer pancreatic cancer and metastatic prostate cancer where the patient have no option but to adhere to the same treatment and suffer the same side effects in order to live longer and perhaps increase their quality of life.
Palliative Radiotherapy:
Is a localised therapy of ionizing radiation in treating disease it is also used to damage cancer cells in high frequency/energy rays to stop cells growth and division. Palliative radiotherapy is recommended when other treatments such as surgical tumour removal cannot be used. It helps in reducing symptoms associated of pain bleeding and decreased function caused by tumour pressure for example brain tumour spinal tumour and tumour near the oesophagus. It can be combined with chemotherapy surgery or both. It is usually a one-time unrepeated course of treatment the treatment plan include three treatments on day 0 7 and 21. (11)
Side effects depend on the treatment dose and the treated part of the body. In most cases they are not permanent and controllable. Patient may experience skin reactions loss of appetite and neutropenia. (9)
Hormone Therapy:
Hormones help some types of cancer cells to grow such as breast cancer and prostate cancer. In other cases hormones can kill cancer cells make cancer cells grow more slowly or stop them from growing. Hormone therapy as a cancer treatment may involve taking medications that interfere with the activity of the hormone or stop the production of the hormones. It may also involve surgically removing a gland that is producing the hormones. The type of hormone therapy depends upon many factors such as the type and size of the tumor patients age the presence of hormone receptors on the tumor. (1213)
Tamoxifen (Nolvadex) is the medication of choice to treat breast cancer by blocking the effects of estrogen on the growth of malignant cells in breast tissue. However tamoxifen does not stop the production of estrogen. (13)
Side effects may be severe mild or absent and may include Headaches Nausea and/or vomiting Skin rash Impotence and Decrease in sexual interest
Biological Therapy:
This type of therapy uses the bodys immune system to fight cancer. Its designed to boost the immune system either directly or indirectly by Making cancer cells more recognizable by the immune system and therefore more susceptible to destruction. (13.14)
Types of biological therapies used include(1314):
1. Nonspecific immunomodulating agents: stimulate the immune system to produce more cytokines and antibodies.
2. Biological response modifiers: produced in a laboratory and given to patients. Drugs used include interferons interleukins colony-stimulating factors monoclonal antibodies cytokine therapy and vaccines.
Side effects may include fever chills aches and fatigue. Other side effects include a rash or swelling at the injection site.
(B) Palliative Cancer Care:
Palliative cancer care is usually implemented from the time of diagnosis during and after cancer treatment and end of life care. It is the total focus of care when cancer treatment is no longer effective. Palliative care take place in hospitals and cancer centres under responsibilities of trained health care professionals who work as part of a multidisciplinary team to coordinate care. It may also be offered in hospice for patients with terminal stage of cancer usually life expectancy of 6 months or less and approaching end of life (5).
Although it shares the same principle of palliative treatment of improving the patients quality of life palliative care goal is not to cure but to support and comfort. Family members and relatives are usually affected in terms of extra responsibilities placed upon them stress emotional instability and uncertainty they may also be included as part of the emotional and spiritual support provided in palliative care. (15)
Treatment modality can be described as Combined Modality Therapy when more than one therapy is prescribed such as combination of radiotherapy and chemotherapy. When the treatment is given after the primary cancer treatment is completed to improve the chance of a cure then it is described as Adjuvant Therapy. It is also known as Neoadjuvant Therapy when more than one therapy are used especially when cancer treatment is given before the primary therapy to contribute to the effectiveness of the primary therapy. (1617)
Examples of combined-modality treatment for palliation (17):
Radiotherapy followed by Surgery:
Removal of neck lymph nodes by neck dissection after radiation therapy for cancers of the mouth or throat region. The operation is done to reduce the risk of recurrence in the neck and improve the chance of cure.
Adjuvant radiation therapy given before surgery for rectal cancer to reduce the risk of recurrence increase the likelihood of cure and reduce the likelihood that the patient will require a permanent colostomy.
Chemotherapy followed by radiotherapy:
In Hodgkins disease chemotherapy is administered into two to three cycles before radiation therapy to improve the probability of cure.
Surgery followed by chemotherapy and radiotherapy:
In moderate to advance stages of breast cancer where subtotal mastectomy or radical mastectomy is the first choice of treatment followed by chemotherapy and/or radiotherapy according to the tumour grading/staging and extend of metastasis aiming to cure or increase survival rate. Hormonal therapy may be introduced at some stage. The same strategy applies to thyroid cancer.
Drug modality:
A study on the colorectal cancer treatment showed that the combination of COLO 205 cells with metformin and silibinin would decrease cell survival resulting in the expression of activated caspase 3 and apoptosis inducing factor followed by apoptosis when applied at a dose insufficient to influence the non-malignant cells [Human colonic epithelial cells (HCoEpiC)]. This shows a potential drug modality method for the treatment of colorectal cancer. (18)
anti-angiogenic therapy:
Angiogenesis inhibitor is the chemical that interferes with the signals to form new blood vessels in order to cut blood and oxygen supply from cancer cells thus preventing metastasis. Bevacizumab (Avastin) became the first anti-angiogenesis drug to be approved for treating cancer. (18)
Hyperthermia:
Hyperthermia is heat therapy. Heat can be applied to a very small area or to an organ or limb. It is usually used with chemotherapy radiation therapy and other treatment therapies.
Complementary medicine: used combination with other alternative treatments or standard/conventional medicine to relief symptoms and improve quality of life this include massage therapy dietary and herbal supplements physical exercise and hypnosis. (13)
Example of a cancer where palliative treatment is used:
Lung Cancer:
Is one of the unpredictable types of cancers that may turn into an aggressive form after being dormant for more than 20 years.
A small study that included smokers ex-smokers and people who had never smoked found that after the first genetic mutations that can cause cancer had been triggered the disease can exist for many years before additional genetic faults cause it to suddenly flare up. (19)
More than 43000 people in the UK are diagnosed with lung cancer each year and despite some positive steps being made against the disease it remains one of the biggest challenges in cancer research with fewer than 10% surviving for at least 5 years after diagnosis. (19)
Two-thirds of patients are diagnosed with advanced forms of lung cancer when treatments are less likely to be successful.
The most common type of lung cancers is non-small-cell lung cancer (NSCC) accounting for around 80% of all cases.
Non-small-cell lung cancer is divided into three types: squamous cell carcinoma adenocarcinoma and large-cell carcinoma.
The symptoms depend on the primary tumours size its location in the lung the surrounding areas affected by the tumour and the sites of tumour metastasis if any. Symptoms related to the primary tumour may include any of the following (19)
Cough Shortness of breath Difficulty taking a deep breath wheezing haemoptysis pneumonia or other recurrent respiratory infection pain in the chest side or back hoarseness difficulty swallowing or other symptoms in the face neck or arms due to infiltration by a tumour
Symptoms of metastatic lung tumours which have spread from the lung depend on location and size. Lung cancer most often spreads to the liver the adrenal glands the bones and the brain. About 30-40% of people with lung cancer have some symptoms or signs of metastatic disease. (1920)
The goals of treatment for non-small-cell lung cancer are to remove or shrink the tumour and to kill all remaining tumour cells.
Treatment options will depend on the staging spread and locations of tumours and include (1920):
Surgery: which involves tumour surgical removal such as lobectomy pneumonectomy or segmentectomy. Lymph nodes excision is also common.
Chemotherapy: Because of its tendency to spread extensively small-cell lung cancer is typically treated with combination chemotherapy which is the use of more than one drug and often in conjunction with radiotherapy.
Radiotherapy: After lung cancer surgery radiotherapy and chemotherapy may be necessary to kill remaining cancer cells but is usually delayed for at least a month while the surgical wound heals. Non-small-cell lung cancers that cannot be treated with surgery are usually treated with radiotherapy and chemotherapy.
Laser therapy: A narrow beam of intense light called a laser is used to kill cancer cells.
Biological therapy.
Inoperable NSCLC is treated with chemotherapy or a combination of chemotherapy and radiotherapy. Biological therapies may also be used.
References:
(1)World Health Organization. WHO Guide for Effective Programmes : Cancer Control : Knowledge into Action : Diagnosis and Treatment. Albany NY USA: World Health Organization (WHO) 2008.
(2) Brown Carlton G. Guide to Oncology Symptom Management. Pittsburgh PA USA: Oncology Nursing Society 2010. Page 14-symptoms in older Adults.
(3) http://www.who.int/cancer/palliative/definition/en/. Accessed 02/02/2015
(4) http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/what-is-palliative-treatment-and-when-should-it-be-used. Accessed 02/02/2015
(5) http://www.cancer.gov/cancertopics/advanced-cancer/care-choices/palliative-care-fact-sheet. Accessed 12/02/2015
(6) Cameron-Taylor Erica. Palliative Approach: A Resource for Healthcare Workers. Cumbria GBR: M&K Update Ltd 2012.
(7)http://www.royalsurrey.nhs.uk/antiemetics. Accessed 20/02/2015
(8) http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-physically/pain/treatment/drugs/types-of-painkillers. Accessed 25/02/2015
(9) http://www.medicinenet.com/script/main/art.asp?articlekey=2698. Accessed 25/04/2015
(10) http://www.kevinmd.com/blog/2014/01/role-chemotherapy-palliative-care.html. Accessed 18/02/2015
(11) http://www.cancer.gov/cancertopics/treatment/types/radiation-therapy/radiation-fact-sheet. Accessed 25/02/2015
(12) http://www.cancer.gov/ncicancerbulletin/NCI_Cancer_Bulletin_090908/page3. Accessed 15/02/2015
(13)https://www.massey.vcu.edu/cancer/treatment/other/hormone/. Accessed 23/02/2015
(14) http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment. Accessed 20/02/2015
(15) http://www.webmd.com/palliative-care/palliative-care-topic-overview. Accessed 20/04/2015
(16) http://www.who.int/cancer/treatment/en/. Accessed 20/04/2015
(17) http://radonc.med.ufl.edu/about/an-introduction-to-radiation-therapy/total-body-irradiation/twice-a-day-irradiation/combined-modality-therapy/. Accessed 25/04/2015
(18) http://www.ncbi.nlm.nih.gov/pubmed/25892866. Accessed 20/04/2015
(19)Elza C. de Bruin Charles Swanton et al Science.Spatial and temporal diversity in genomic instability processes defines lung cancer evolution http://www.webmd.boots.com/lung-cancer/guide/surgery-lung-cancer. Accessed 25/04/2015
(20) http://www.webmd.boots.com/lung-cancer/guide/palliative-care-for-lung-cancer. Accessed 25/04/2015
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