Critically appraise the evidence base related to the management of a variety of adult and paediatric cancers with a focus on radiotherapy and associated side effects, risks and benefits.

 

Assessment 1: Essay (2500 words +/-10%)
This is a summative assessment worth 50% of the module
Learning outcomes assessed:

1. Consider the clinical presentation, natural history and management of a variety of adult and paediatric cancers.

2. Relate knowledge and understanding of the psychosocial aspects of cancer to management of patients within the radiotherapy setting.

 

4. Critically appraise the evidence base related to the management of a variety of adult and paediatric cancers with a focus on radiotherapy and associated side effects, risks and benefits.

 

 

For this assignment you will write a structured essay on ONE of the four cases given below. You will format/prepare your essay by following the information and structure given in the template below.

 

Each case is hypothetical and has some relevant social and medical history included. You may add additional detail if you wish (e.g. for three cases sex/gender is deliberately excluded, but if you wish to base your essay on a male/female/non-binary patient, you can include the extra information as an appendix to your essay, but don’t include that extra information unless it is pertinent to any of your essay content/discussions).

 

 

Choose one of the following cases to write about:

 

 

Case A

64-year-old patient with maxillary antrum cancer, staged T3N0M0. The patient originally presented with inflammation of the left cheek, proptosis and visual disturbance of the left eye and a foul taste in their mouth, along with episodes of facial pain. The patient is a smoker with a 10 cigarettes per day habit of around 40 years. They have recently been diagnosed with mild chronic obstructive pulmonary disease (COPD). Their socioeconomic status would be classed as “routine occupation”. The patient is currently working part time as a customer services manager in a local retail outlet but was planning to retire in 9 months when aged 65.

 

Case B

46-year-old male patient who is HPV positive, with recurrent oropharyngeal cancer of tonsillar origin, with ipsilateral nodal spread to level 2 and 3 cervical nodes (staged T2N2M0). He has had previous surgery to remove the primary tumour, but no previous neck dissection. He admits to drinking more than 40 units of alcohol per week and is under the care of an alcohol dependency service, although he gave up smoking when originally diagnosed. His socioeconomic status would be classed as “never worked/long term unemployed”.

 

 

Case C

58-year-old patient with histologically aggressive tumour of the anterior 2/3 tongue – staged at T2N0M0. The patient is a lecturer at a further education college, having completed master’s level education, therefore their socioeconomic status would be classed as “Higher managerial/ administrative/ professional”. The patient admits to smoking and drinking regularly but not heavily.

 

 

Case D

75-year-old patient with a high grade adenocarcinoma of the parotid gland (salivary) staged at T3N1M0. The patient was diagnosed with type 2 diabetes 15 years previously. Their notes suggest this is not well-controlled, as they have developed retinopathy and peripheral neuropathy and are prone to leg ulcers.  Their socioeconomic status would be classed as “Lower supervisory and technical” prior to retirement.

 

Template for essay structure:

Section 1: Staging summary – include info/evidence regarding extent/spread of disease
Cancer Type/Location/Histologic type: Diagnosis Date:

 
Tumor size:                               Lymph Nodes:                         Metastasis:

 

Stage:   ☐I   ☐II   ☐III   ☐IV   ☐Not available/applicable

 

No more than 200 words: Relevant information related to the stage: e.g. evidence regarding prognosis related to the histology or stage; suggestions regarding trt that is not suitable due to the diagnosis etc.

 
Section 2: Management: Initial Treatment plan ~ 900 words

Critically evaluate the treatment options suitable for management of this patient, ending with your proposed, evidence-based treatment plan. This should include a timeline for treatments and whether they are neoadjuvant, adjuvant or concurrent/concomitant.

 

You should highlight the strengths and weaknesses in the evidence you review. Critical discussion related to acute side effects/morbidity of each treatment modality should be included to help justify your options. Any aspects of your patient’s social/medical history that might impact the initial management plan should form part of your deliberations. This may include any supportive management required to optimize the patient’s performance status prior to commencing active management.
Section 3: Supportive Management: On-treatment plan ~ 700 words

Critically evaluate evidence related to appropriate psychological and social support of your chosen patient. Strengths and weaknesses of the relevant evidence should be noted. You must include reference to wider support options and therapeutic support options, tailored to the specific diagnosis and medical history.

 

This section should not include a detailed description of physical side effect management, however if psychosocial functioning is impacted by physical effects of the treatments chosen, this should be referred to. (e.g. if surgery causes extensive scarring that impacts on body image/self-confidence etc., you can mention this but the focus should be on the support required by the patient, not a description of the issue that caused the support to be required).

 
Section 4: Follow-up/long term care plan ~ 700 words

Critically evaluate evidence related to the likely long-term effects of treatment that your patient might experience in order to suggest a long-term management plan. You should consider both the physical and psychosocial needs of your patient in this section.

 

You should not include a detailed list/description of all possible side effects, but focus on the management required, highlighting the strengths and weaknesses in the evidence base used in your discussion/justification.

 

Points to consider:

 

  • The word counts given for each section are approximate and the total word count for the whole essay should not exceed 2500 +/- 10%.
  • In all sections of the essay it is expected that you will use multiple sources of evidence to comprise the evidence base from which you construct your evaluation and discussion.
  • You will need to synthesis the evidence and use your original thoughts and opinions that arise from that synthesis. (Please refer to the academic skills advice webpage for resources on how to synthesise and critically evaluate literature)
  • You will need to question the literature and spend a significant amount of time carrying out background research and note taking before beginning to construct your essay.

Presenting your assignment:

 

  • Provide a suitable front page highlighting your chosen case and give your word count – do not include your name.
  • Use a font size no smaller than 11 and an easily read type face such as Calibri (please don’t use Times New Roman or similar, as your markers find this more tiring to read)
  • Set your line spacing to 1.5 or 2 x line spacing (again, easier for your markers to read)
  • Ensure you use sentences and paragraphs appropriately: a new paragraph should signal a new topic/aspect of discussion and paragraph spacing should not be used to break up large areas of text.)
  • This is a structured essay so you DO NOT need to provide an introduction or conclusion either to the whole piece or to each section, just follow the template given.
  • The assignment should be fully referenced with citations and reference list formatted according to the School of Health and Social Work referencing guidelines http://academic-skills.health.herts.ac.uk/referencing/
  • If you choose to use an electronic reference management system, it is still your responsibility to manually check all citations and references to ensure they are correctly formatted.