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Abstract

Ovarian cancer is a great challenge for women, according to the Healthy People 2020 project that insists on managing the threatening disorder. The paper is focused on the analysis of ovarian cancer among white women whose age varies from 25 to 50. The prevalence of ovarian cancer among women is great. It was found that age is the risk factor for this disorder. In particular, younger women have less predictability regarding this disorder in comparison to older women. Moreover, the younger women represented a higher survival rate in comparison to the older women. As the intervention, the immunotherapy or immunoprevention that is believed to be an effective tool in managing the disorder with fewer side effects in comparison to the other treatments was proposed. APRN plays a great role in this intervention implementation. It has to explain to the patients all possible information, including the benefits and disadvantages of this intervention. Therefore, ovarian cancer is a great threat to white women from 25 to 59 years that can be treated by immunotherapy as an efficient intervention.

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Ovarian Cancer

Introduction

Nowadays, ovarian cancer is a great problem for women from a global perspective. The US population is a vivid example since here the rate of the disorder is great. To improve the general health and well-being of women the Healthy People 2020 initiative that represents the main health challenges was provided. One of the problems covered by it is ovarian cancer among women due to the great mortality prevalence of this disorder. It is critical to analyze ovarian cancer among white women aged 25 to 50. Based on this analysis, it is possible to realize that age is one of the main risk factors for ovarian cancer, because younger women have less predictability of ovarian cancer in comparison to older women, and it's the same when it comes to survival. Therefore, there is a great need to address the ways of effective intervention. APRNs can play a great role in establishing the chosen intervention in the care plan of the patient through explaining all aspects of the treatment and providing individual advice and recommendations. Therefore, ovarian cancer is a great threat to white women from 25 to 59 years that can be treated by immunotherapy as an efficient intervention.

Ovarian Cancer

Healthy People is the objectives and goals set with ten-year objectives provided for guiding the national health promotion and disorder prevention attempts to improve the health of all populations in the US. Therefore, Healthy People 2020 is the fourth generation of the initiative and its main goals are decreasing, tracking, and measuring health disparities through the health approach determinant, promotion of healthy lifestyle and well-being. This project emphasizes the health of females by addressing sixteen topics and problems they are currently experiencing. One of them is the ovarian cancer challenge because its prevalence is shocking (Simacek, Raja, Chiauzzi, Eek, & Halling, 2017). Therefore, females are under a greater threat due to this disorder.

Most of the ovarian tumor occurs due to the epithelial cells increasing uncontrollably and replicating those of the ovary surface. Such cancer is known as epithelial ovarian cancer (Roett & Evans, 2009). There are several risk factors related to the disorder such as lifestyle, previous gynecological challenges, genetics, menopause and childbirth, age, and family history. The symptoms of the disorders can be very challenging to identify (Roett & Evans, 2009). They can be confused with those of other less severe disorders. Also, there is no routine or simple test for reliable and accurate detection of ovarian cancer, thus screening for this disorder is not feasible. Around seventy percent of women are diagnosed on the third or fourth stage of the disorder (Roett & Evans, 2009). Possible symptoms include abnormal vaginal bleeding, change in bowel movements, fatigue, appetite loss, irregular periods, abdominal pain, and persistent bloating. The diagnosis method varies, but in general, it can involve the ultrasound, the MRI or CT scan, or the blood test for checking the increased protein level in the blood named the CA-125 (Roett & Evans, 2009). Hence, the disorder is highly serious and complicated.

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In addition to the challenging consequences of the physical treatment, patients experience a strong impact on emotional well-being, participation in social and daily activities, as well as personal relationships. The brevity between the treatment and diagnosis results in a lack of time to form the expectations regarding treatment and the ovarian cancer influence on the lives of the patients (Simacek et al., 2017). Therefore, women with this disorder often experience greater stress, uncertainty, and anxiety regarding treatment decision-making (Simacek et al., 2017). Despite the gap between the patient's expectations and hopes and the reality has been thought of as the predictor of poorer health-related life quality, it was not realized as part of decision-making regarding treatment (Simacek et al., 2017). Hence, ovarian cancer is a great challenge for women's health.

Ovarian Cancer Prevalence among White Women Aged 25 to 50

The prevalence of ovarian cancer among white women is great. Every year around 22000 new ovarian cancer cases occur in the US, and more than 14000 women die from this disorder. (Chan et al., 2006) The high mortality rate is related to the fact the around sixty percent of the cases are diagnosed too late (Chan et al., 2006). Even though invasive epithelial ovarian cancer is the most common postmenopausal disorder, women of reproductive age constitute only 20% of all populations (Chan et al., 2006). It was found that young patients with ovarian cancer had a survival rate as high as 75% at all stages in comparison to the 40% of the general population (Chan et al., 2006). Therefore, ovarian cancer is often found in postmenopausal women.

If comparing ovarian cancer prevalence among young and older women, the first category has a better chance to deal with the disorder. It was found that only from three to seventeen percent of patients with ovarian cancer were under forty (Chan et al., 2006). Young age was found to be a poor predictor of breast cancer. Also, most of the report represents that younger women with ovarian cancer have the best results in comparison to older women and have a lower stage and more well-differentiated tumors (Chan et al., 2006). There was research aimed to compare ovarian cancer among young and older women. Hence, out of 28165 patients, four hundred were less than thirty years, 11601 were from thirty to sixty years old and 16164 were more than sixty years old (Chan et al., 2006). Therefore, it was found that among the diagnosed women the I-II stage disorder in older women was at 22%, young patients at 40.2%, and very young at 65% (Chan et al., 2006). Very young women had a great survival advantage in comparison to younger and older groups with five-year disorder-specific survival (Chan et al., 2006). Therefore, age is a critical factor in this disorder because older women have more chances to experience ovarian cancer, and fewer chances to survive it.

Therapeutic Approach

One of the possible approaches to health in the case of ovarian cancer can be immunoprevention. While 70%-80% of patients with advanced ovarian cancer tried to manage their disorder through taxane therapy, more than sixty percent will experience the disorder recurrence and 70% to 90% will die from the disorder (Liu et al., 2010). Nowadays there are immune-based vaccines for ovarian cancer prevention. Host anti-tumor immune responses have the ability to strongly affect the ovarian cancer patient's prognosis (Liu et al., 2010). The tumor-infiltrating lymphocytes presence was related to the strongly improved progression-free and general survival rates among women with an advanced stage of ovarian cancer in comparison to the women without the TILs (Liu et al., 2010). Therefore, considering ovarian cancer is intrinsically immunogenic, it might be possible to provide the anti-tumor immune response through the vaccine application that improves the TIL response and improve the patient's results in preventing the disorder.

Therapeutic vaccination derived from the autologous whole tumor cell lysates can help to provide the host antigen-specific anti-tumoral immune responses. The main vaccine's benefits are the chance to involve immunity with the personalized and broad antigens number and the incorporation of still unidentified tumor antigens. The recent analysis of the 173 immunotherapy trials involving ovarian cancer showed the higher objective clinical response in people gaining the whole tumor antigen-grounded vaccines in comparison to people gaining the synthetic antigens. (Liu et al., 2010) The vaccinations with the antigen-specific dendritic cells (DCs) can provide anti-tumor immunity through specific tumor-antigen presentation and T cell effector activation. There are several approaches to the DC-grounded vaccines, involving the DCs exposure to the whole tumor cell lysates, defined the ovarian tumor peptides, and the ovarian tumor cells to involve the cytotoxic T lymphocyte response (Liu et al., 2010). Hence, such intervention has great potential.

Therefore, immunotherapy is the perspective intervention for ovarian cancer treatment and there are several types of vaccines that can be used. One of them is antibody-grounded vaccines. It became the standard practice in cancer treatment. Hence, CA-125 is a well-research ovarian cancer antigen and this is a surface glycoprotein antigen that elevated in 79% of all patients with ovarian cancer and 95% of patients with the third and fourth stage of this disorder and it was found that half of the patients from the research were successfully induced to generate the anti-CA125 antibody just as the CA125 (Liu et al., 2010). From thirteen patients three had stabilized the disorder and survived for more than two years. Nonetheless, such vaccines, in general, have poor immunogenicity and need to be administrated with such adjuvants as GM-CSF.

The other type is the cytokine vaccines and they provide immune regulation and increase the amplification, induction, and effector properties of the desired immune response in the microenvironment of the vaccination site. The combination of the chemotherapy and cytokine agents was researched in the case of ovarian cancer. It was found that the general response rate was 56% (Liu et al., 2010). The next type is the tumor cell vaccines (Liu et al., 2010). To increase the immunogenicity, the tumor cell vaccines have to be related to the specific adjuvant. Another type is the heat shock protein vaccines (Liu et al., 2010). HSP is famous as the molecular chaperones that have a critical role in helping protein folding. Thus, the number of mammalian HSP when isolated from the tumor cells was shown to elicit tumor-specific immunity and when isolated from the virus-infected cells and showed o elicit virus-specific immunity (Liu et al., 2010). Therefore, immunotherapy and immunoprevention provide several alternatives regarding vaccines that can be applied to women from 25 to 50 in case of ovarian cancer (Liu et al., 2010). Such intervention provides fewer side effects in comparison to other treatments and it is proved to be an efficient intervention in promoting health and well-being (Liu et al., 2010). Hence, these vaccines can be an effective intervention for managing ovarian cancer among women.

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APRN Role

Oncology APRNs have a unique position in educating patients and the public regarding the recommended cancer risk reduction and screening tools and directions. The nurse practice involves the recommendations regarding disorder prevention and health promotion (Gobel, Triest-Robertson, & Vogel, 2009). Cancer prevention and screening are considered to be the major responsibilities of nurses that are critical for diagnosing cancer at the earliest phase. According to the requirements, the APRNs have to be able to interpret, evaluate, assess the cancer risk, and provide a recommendation regarding the best strategies for cancer screening and prevention (Gobel et al., 2009). They have to provide culturally sensitive cancer prevention and early detection services and take part in the resource development that concentrates on primarily retention and wellness through the lifespan (Gobe et al., 2009). Therefore, the role of APRN is great. At the same time, they have to provide the intervention in the care plan of the patient.

In general, the care plan implementation includes the care management activities array through which the care plan is provided. Such activities have involved the representation of information regarding the available services, as well as educating family members and clients regarding ways of accessing services or performing specific care activities by themselves (Doenges, Moorhouse, & Murr, 2010). It can also provide the service coordination that can be explained as the active personal involvement when case managers and family members are provided in arranging for specific services. The patient's health care plan has to be implemented in a timely and cost-efficient way, to increase the patient's independence and choice while applying the less intensive, higher quality, most cost-efficient, and least intrusive interventions (Doenges et al., 2010). Education and information are critical elements of the process because many patients do not have the needed knowledge regarding the long-term care system and need specific instructions regarding the way to increase their access to the needed health service (Doenges et al., 2010). Therefore, the APRN must realize this issue.

Nurses must present all the alternatives of interventions regarding ovarian cancer treatment to women. After that, it is important to explain and discuss all benefits and disadvantages of all mentioned interventions (Doenges et al., 2010). Also, APRN has to provide advice on the best possible intervention and, in this case, it has to be immunotherapy. After discussing all these issues, the nurse and patients have to form their health care plan, based on the chosen intervention and follow it to manage ovarian cancer (Doenges et al., 2010). Additionally, the nurse has to give emotional support and empathy to the patient to reduce the psychological pressure of the disorder. Hence, the role of the APRN in helping patients managing ovarian cancer is great.

Conclusion

Ovarian cancer is a serious challenge for women's health in the US. It is the fifth leading cancer death cause among women. The prevalence of mortality rates in the case of ovarian cancer is great. The main challenge is the difficulty to screen and identify this disorder. It is a common case when ovarian cancer is identified in the last stages and the treatment has to be applied as fast as possible. The ovarian cancer prevalence can be analyzed among white women whose ages vary from 25 to 50. It is possible to conclude that age is a risk factor for ovarian cancer because it was found that younger women have less predictability regarding this disorder in comparison to older women. Moreover, the younger women presented a higher survival rate in comparison to the older women. Therefore, ovarian cancer is a great challenge for women's health and it has to be addressed according to Health 2020. One of the proposed interventions is immunotherapy or immunoprevention. This therapy is relatively new in comparison to other interventions, but it has great potential. In particular, it was researched to provide the greatest positive influence and to have fewer side effects in comparison to other intervention alternatives. A great role in this intervention implementation plays an APRN that has to provide the patients with all possible information, including benefits and disadvantages of this intervention. It is critical to support the patient and provide efficient service in applying this intervention to the health care plan.

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