Experiences of Japanese Patients With Colorectal Cancer During the First Six Months After Surgery

Perioperative experiences and needs of patients who undergo colorectal cancer surgery and their family caregivers: a qualitative study

PURPOSE

Colorectal cancer (CRC) surgeries are major, complex, and often associated with debilitating symptoms or significant deconditioning that may impair patients' quality of life. Little is known about how patients and family caregivers cope and their unmet needs during this daunting perioperative phase. This study aimed to explore the experiences and needs of CRC patients who undergo surgery and their family caregivers.

METHODS

An exploratory qualitative design was adopted. A total of 27 participants comprising fifteen outpatients who had undergone colorectal cancer surgery and twelve family caregivers were recruited through purposive sampling from a public tertiary hospital in Singapore between December 2019 and November 2020. Individual, audio-recorded, semi-structured interviews were conducted, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Four themes emerged: initial reactions to the diagnosis, impact of the illness and surgery, personal coping, and external support. The lack of apparent assessments on the psychological well-being of patients was found despite several participants exhibiting early signs of distress. Access to psychological support provided by healthcare professionals or peers was selective, and knowledge deficit was prevalent, especially in the preoperative stage.

CONCLUSION

Psychological priming and strengthening are important for CRC patients' and their caregivers' adaptive coping throughout the treatment continuum. Technology-based, dyadic psychoeducation should be offered preoperatively to ease CRC patients' acceptance of their diagnosis and adjustment to life after surgery while at the same time reduce the burden of family carers.

Going through laparoscopic liver resection in patients with colorectal liver metastases-A qualitative study

AIM

Colorectal cancer is one of the most common cancers worldwide. Surgery is seen as the only curative treatment. There are two approaches to liver resection: open or laparoscopic surgery. Knowledge from the patient perspective can illuminate how it is experienced going through laparoscopic surgery. We aimed to study patient perspectives of the experience of undergoing laparoscopic liver resection surgery in patients with colorectal liver metastases.

DESIGN

This study has a qualitative research design. Nine patients participated in semi-structured interviews 6 months after surgery. Data were analysed according to Kvale's five-step analysis method.

RESULTS

Though the patients were satisfied with the laparoscopic approach, they expressed unmet informational needs about the new technique, time after discharge and surgery outcomes related to having metastatic cancer. Healthcare professionals should provide information and support that recognizes the needs of patients with cancer undergoing laparoscopic liver resection surgery.

Relationship between the Physical and Psychosocial Conditions of Postoperative Gastrointestinal Cancer Patients and their Responses to an Informational Material

Objective:

Postoperative patients with gastrointestinal (GI) cancer have multiple adaptation tasks and care needs to improve their quality of life (QOL). Whether their supportive care needs differ according to their physical and psychosocial conditions is unclear. This study investigated patients’ (1) physical and psychosocial conditions (QOL, fatigue, anxiety, cognitive plight, and resilience) and (2) responses to an informational booklet describing cancer patients’ problems and adaptation tasks, and examined the association between the two factors.

Methods:

A questionnaire survey was conducted to postoperative patients with GI cancer.

Results:

The mean age of the 69 respondents was 63 years; 59.4% of the respondents were men. Nine patients who did not read the booklet showed high fatigue and cognitive plight and low QOL. The patients (36.2%) who chose “I vaguely understood the content” showed low scores for resilience and cognitive plight while those (8.5%) who chose “I will deal with my tasks as described in the scenarios” showed high scores for both of these variables.

Conclusions:

The condition of some patients continued to be highly affected by their cancer. In terms of understanding the contents of the booklet, resilience was significant, and cognitive plight did not necessarily have a negative impact. The provision of information by means of a booklet might not be suitable for patients who are highly affected by their cancer. Patients may need additional support to be able to make good use of the information provided in such a booklet.

Psychological Stress and Coping in Recently Discharged Postsurgical Cancer Patients

Objective:

Cancer patients and survivors need to cope with various stressful situations and problems even after treatment. In this study, we sought to investigate psychological stress and coping in recently discharged postsurgical cancer patients.

Methods:

A mail-in questionnaire survey about stress response, perceived illness-related demands, and coping strategies and styles was administered to postsurgical Japanese cancer patients. The questionnaires were returned a week after the patients’ discharge from the hospital. Descriptive and nonparametric statistical analyses were used.

Results:

Forty-two patients completed the questionnaire; their average age was 58.1 years, and 61.9% were female. The stress response scale-18 (SRS-18) score was lower than that reported among the general population. The proportion of patients who were concentrating coping on social support or positive reappraisal was high. The scores for problem- and emotion-focused coping were nearly identical. SRS-18 scores were weakly correlated with those for emotion-focused coping (r = 0.38, P = 0.014). The demographic data were not significantly associated with any of the stress or coping variables. However, SRS-18 scores for patients who had adjuvant therapy and physical, functional disorders were significantly higher than those for patients who did not (P = 0.004 and P = 0.008, respectively).

Conclusions:

Most of the patients had a low-stress response and used appropriate coping strategies. However, the findings suggest that attention must be paid to stress-coping in patients who have a physical, functional disorder as well as in those receiving adjuvant therapy.

Living With Cancer Alone? The Experiences of Singles Diagnosed With Colorectal Cancer

This paper seeks to understand the experiences of single colorectal cancer patients. This study consisted of 12 semi-structured interviews that were digitally voice-recorded, transcribed, and analyzed. Six main themes emerged: (a) gradual shift in view of cancer diagnosis from fatalistic to normalized, (b) perception of cancer as a nadir experience, (c) concerns of singlehood, (d) factors influencing cancer experiences, (e) factors influencing coping with cancer, and (f) range of responses towards cancer diagnosis. Singles with colorectal cancer require short- to long-term individualized care plans, and psycho-emotional support. This may help enhance their individual coping and adjustment to the diagnosis.

Men's reflections on participating in cancer rehabilitation: a systematic review of qualitative studies 2000-2013

This paper aims to report on a systematic review of qualitative studies on men's reflections on participating in cancer rehabilitation. Nine databases were systematically searched to identify qualitative papers published between 2000 and 2013. Papers were selected by pre-defined inclusion criteria and subsequently critically appraised. Key themes were extracted and synthesised. Fifteen papers were selected and represented. Four central themes were identified in the analytical process: 'changed life perspective', 'the masculinity factor', 'a desire to get back to normal' and 'the meaning of work'. Six peripheral themes were identified: 'the meaning of context', 'music', 'physical training', 'religion', 'humour' and 'the unmentionable'. The themes were synthesised into an integrative model representing men's reflections on participating in cancer rehabilitation. We conclude that existing qualitative literature offers insight into men's reflections on cancer rehabilitation and highlights the interrelationship between men's reflections on their changed life perspective, masculinity, orientation towards a normal life and getting back to work. Further research-based knowledge is needed to explore (1) the underlying causes and patterns of the men's needs, preferences and choices in rehabilitation; and (2) the health professional perspective on male cancer rehabilitation.

Review of bowel dysfunction of rectal cancer patients during the first five years after sphincter-preserving surgery: a population in need of nursing attention

PURPOSE

The aim of the review was to summarize the longitudinal changes in bowel dysfunction among patients with rectal cancer within the first five years following sphincter-preserving resection.

METHODS

A series of literature searches were conducted on six English-language electronic databases. Articles published after 1990 were searched. A total of 29 articles (reporting 27 studies) was found.

RESULTS

Bowel dysfunction, including an alteration in the frequency of bowel movements, incontinence, abnormal sensations, and difficulties with evacuation, is reported among patients with rectal cancer within the first five years after sphincter-preserving resection. These problems are most frequent and severe within the first year, especially within the first six months, and stabilize after one year. Some of the problems may last for years.

CONCLUSION

Supportive care for bowel dysfunction is needed, and should include the provision of information and psychological support delivered in multiple steps. Oncology nurses can play an important role in providing supportive care for rectal cancer patients with bowel dysfunction.

Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer

The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.

Information needs across the colorectal cancer care continuum: scoping the literature

Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.

Adaptation status and related factors at 2 time points after surgery in patients with gastrointestinal tract cancer

BACKGROUND

The diagnosis of cancer and subsequent surgery represent a life-threatening and stressful experience with several factors relating to the patient's process of adaptation.

OBJECTIVE

The purpose of this longitudinal study was to examine adaptation status and related factors in patients who have been diagnosed with and undergone surgery for gastrointestinal tract cancer.

METHODS

The survey was administered twice (2 weeks after discharge from the hospital and 6 months after surgery). Twenty-five patients responded to both questionnaires about quality of life (QOL), which was regarded as an index of adaptation status, and illness-related demands, the "why me?" question, sense of coherence (SOC), perceived social support, and disease data.

RESULTS

On the second survey, scores about illness-related demands, the "why me?" question, SOC, and QOL, other than the QOL social relationships domain, improved, but scores about perceived social support decreased. A correlation between the "why me?" question and the SOC and the difference in the overall QOL by cancer site were found only on the second survey. Low demands of illness and high SOC predicted high QOL on both surveys.

CONCLUSIONS

Except for social relationships, adaptation status 6 months after surgery improved compared with after discharge. The relationships between some variables took on a significant meaning at 6 months after surgery.

IMPLICATIONS FOR PRACTICE

Comparisons between 2 time points suggested that most cancer patients had dispositional resilience. Meanwhile, the findings related to social relationships and the relationships between some variables suggested the necessity for professional interventions targeting these factors.

Laparoscopic surgery for endometrial cancer: a phenomenological study

AIM

This paper is a report of a study of women's perspectives on the experience of laparoscopic surgery for endometrial cancer.

BACKGROUND

Laparoscopic surgery is increasingly used to treat early endometrial cancer. It is associated with low levels of morbidity and is considered safe as cancer surgery, but research on quality of life and women's experiences is limited.

METHOD

Heideggerian hermeneutic phenomenology was used to explore the experiences of 14 women who had undergone the procedure in two English cancer centres between February 2008 and July 2009. In-depth interviews were taped, transcribed and analysed using Colaizzi's framework.

FINDINGS

A phenomenological description was produced from five identified themes: having cancer, transfer of responsibility to the surgeon, information and support, independence, and normality. The experience of laparoscopic surgery was overshadowed by the presence of cancer. Fear and lack of knowledge played an important role in entrusting the surgeon with the responsibility for decision-making. Individual, unmet information needs focused on the practicalities of treatment and being in an unfamiliar situation and environment. Loss of control and vulnerability were associated with illness and surgery, but early postoperative mobility and reduced pain, facilitated rapid return to independence and maintained a sense of normality.

CONCLUSION

Healthcare professionals should deliver care in early endometrial cancer in a way that recognizes the significance of the cancer diagnosis, the role of the surgeon in decision-making and the need for practical information. Women with endometrial cancer should have access to treatments that reduce dependency and maintain normality.