Untreated peristomal skin complications among long-term colorectal cancer survivors with ostomies

This ethnography of family caregiving explored why peristomal skin complications are common and undertreated among colorectal cancer survivors with intestinal ostomies. Data were collected through in-depth interviews with 31 cancer survivors and their family caregivers, fieldwork, structured assessments, and medical records review, and analyzed with qualitative theme and matrix analyses. Survivors who received help changing the skin barrier around their stoma had fewer obstacles to detection and treatment of peristomal skin complications. Half of the survivors received unpaid help with ostomy care, and all such help came from spouses. Married couples who collaborated in ostomy care reported that having assistance in placing the ostomy appliance helped with preventing leaks, detecting skin changes, and modifying ostomy care routines. In addition, survivors who struggled to manage ostomy care independently reported more obstacles to alleviating and seeking treatment for skin problems. Oncology nurses can improve treatment of peristomal skin problems by asking patients and caregivers about ostomy care and skin problems, examining the peristomal area, and facilitating routine checkups with a wound, ostomy, and continence nurse.     

The return to work experiences of colorectal cancer survivors.

During the past 15 years, the number of colorectal cancer survivors has risen dramatically. While it is unclear how many colorectal cancer survivors were employed at the time of diagnosis, it is reasonable to expect a significant proportion of these survivors were temporarily displaced from the work force. This article describes the return to work experiences of 250 colorectal cancer survivors. The majority (80%) of the survivors were employed at diagnosis and 89% returned to work. Of those who returned to work, 81% sustained employment 5 years postdiagnosis. Results indicate survivors were successful in their attempt to return to work and sustain employment. However, 34% of survivors delayed their return beyond 2 months postdiagnosis. After controlling for ethnicity, education, and disease severity, the reason for delay was related to chemotherapy treatment. Prospective studies of colorectal cancer survivors to document barriers to work return can guide interventions and occupational services to keep survivors healthy and in the workplace.     

Psychological distress among adult cancer survivors: importance of survivorship care plan

Purpose

The goal of our study was to better understand the importance of adult cancer survivors (ACS) receiving Survivorship Care Plans (SCP) especially for their psychological well-being. We hypothesize that the receipt of SCP would decrease the likelihood of symptoms of current depression (SCD) in this population.

Methods

We tested our hypothesis by using a representative sample of ACS, more than 1 year from cancer diagnosis, who responded to the 2010 BRFSS survey. We used follow-up care instructions (FCI) and treatment summaries (TS) as a marker of SCP. Weighted multivariable logistic regression models were used to investigate the association between FCI and TS (individually and in combination) and SCD, among short-term (≤5 years from cancer diagnosis) and long-term (>5 years from cancer diagnosis) ACS.

Results

Out of 3191 final study participants, 32.8 % were short-term, and 67.2 % were long-term ACS. Among short-term ACS, the adjusted odds of SCD were 3 times higher (adjusted odds ratio (AOR) 3.14 [95%CI 1.29–7.65]) for those who did not receive TS + FCI than for those who received them both. Among long-term ACS, the adjusted odds of SCD were more than twice higher (AOR 2.18 [95%CI 1.14–4.19]) for those who received FCI and no TS compared to those who received them both.

Conclusion

The present study results emphasize the importance of ACS receiving SCP. Adult cancer survivors may highly benefit from the receipt of SCP not only short-term but also long-term for their overall psychological well-being.

     

Ensuring quality care for cancer survivors: implementing the survivorship care plan

OBJECTIVES: To review emerging strategies to improve upon the coordination of care for cancer survivors through the adoption and promotion of cancer treatment summaries and survivorship care plans. Special attention is focused on the needs of childhood cancer survivors. DATA SOURCES: Reports from the Institute of Medicine and the President's Cancer Panel, and work being performed by several professional societies. CONCLUSION: Cancer care is poorly coordinated during and after treatment. The growing number of cancer survivors demands innovative strategies to improve the quality and coordination of post-cancer patient care. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an important role in the implementation and delivery of treatment summaries and survivorship care plans. Incorporation of cancer prevention and health promotion counseling is a natural activity for nurses as the health care system focuses on improving care for cancer survivors.     

Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status

Purpose

Research examining effects of ostomy use on sexual outcomes is limited. Patients with colorectal cancer were compared on sexual outcomes and body image based on ostomy status (never, past, and current ostomy). Differences in depression were also examined.

Methods

Patients were prospectively recruited during clinic visits and by tumor registry mailings. Patients with colorectal cancer (N?=?141; 18 past ostomy; 25 current ostomy; and 98 no ostomy history) completed surveys assessing sexual outcomes (medical impact on sexual function, Female Sexual Function Index, International Index of Erectile Function), body image distress (Body Image Scale), and depressive symptoms (Center for Epidemiologic Studies Depression Scale—Short Form). Clinical information was obtained through patient validated self-report measures and medical records.

Results

Most participants reported sexual function in the dysfunctional range using established cut-off scores. In analyses adjusting for demographic and medical covariates and depression, significant group differences were found for ostomy status on impact on sexual function (p?<?.001), female sexual function (p?=?.01), and body image (p?<?.001). The current and past ostomy groups reported worse impact on sexual function than those who never had an ostomy (p?<?.001); similar differences were found for female sexual function. The current ostomy group reported worse body image distress than those who never had an ostomy (p?<?.001). No differences were found across the groups for depressive symptoms (p?=?.33) or male sexual or erectile function (p values?≥?.59).

Conclusions

Colorectal cancer treatment puts patients at risk for sexual difficulties and some difficulties may be more pronounced for patients with ostomies as part of their treatment. Clinical information and support should be offered.     

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

Purpose

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors.

Methods

Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976–2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T?≥?57 on two of three scales or the Global Severity Index were considered distressed.

Results

We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects.

Conclusions

Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.     

Patients' experiences of 'feeling on their own' following a diagnosis of colorectal cancer: a phenomenological approach

The aim of this paper is to describe a Hermeneutical phenomenological study of the experience of being diagnosed with colorectal cancer. The research objective was to understand this particular lived experience and uncover the meanings and structures within it. Eight patients who had been diagnosed with colorectal cancer in the preceding four weeks were purposively sampled to describe their experiences. Data was generated using semi-structured, in-depth, face-to-face interviews. The data was analysed using the method described by Benner. Six themes were identified as the main components of this experience for these patients. An overview of the participants’ experiences is presented followed by a more detailed discussion of one of the most poignant themes, which is entitled ‘Feeling ‘on your own’’.     

Reach for recovery: Evaluating a pilot study of a colorectal cancer survivorship programme

PurposeMore people are living with and beyond a cancer diagnosis and new models of care are required which not only help cancer survivors meet their needs after cancer treatment but also offer guidance on how they might optimize their future quality of life.Methods‘Reach for recovery’ is a programme of educational group support which was designed specifically for colorectal cancer patients on completion of treatment. This new initiative consisted of weekly sessions offering group support and information to promote recovery from treatment and transition into cancer survivorship. The first two programmes constituted a pilot study and were evaluated to inform future content and development.ResultsA total of seventeen patients participated in the first two programmes. Completed evaluations (n = 13) revealed that the content of the programme was perceived to be beneficial, the sessions were rated as informative and relevant to individual needs and participants had enjoyed meeting others in a similar situation. While nearly all eligible patients expressed interest in the programme, less than half of those invited attended more than one session. Establishing the resources for the programme and recruiting participants to the programme proved resource-intensive and this may limit its sustainability.ConclusionThis initiative was well received by both cancer survivors and clinicians and offered both support and education at a critical transition time in colorectal cancer patients entry into survivorship. Careful consideration must be given to the programme venue, frequency and timing for the successful delivery of such initiatives.     

Nurses' experiences of a colorectal cancer screening pilot

This article describes a study that set out to explore the experience of endoscopy nurse practitioners participating in the Department of Health-funded UK Nurse-led Flexible Sigmoidoscopy Colorectal Cancer Screening Pilot. Semi-structured interviews were conducted with the three nurse practitioners involved and were analysed using Thematic Analysis, a qualitative method for analysing and reporting patterns (themes) within data. Nurse practitioners found that participating in the study improved their skills and provided job satisfaction despite the hard work it entailed. A varied workload consisting of diagnostic and screening procedures, in addition to the other duties of nurse practitioners, may be desirable for nurses working in the field of gastroenterology.     

Patients' experiences of living beyond colorectal cancer: A qualitative study

Purpose of the researchThis paper is a report of a study of the experiences of individuals with colorectal cancer in the period following their cancer treatment and the physical, psychological and social aspects associated with adjusting to everyday life.Methods and sampleQualitative interviews using a phenomenological approach were conducted with a purposive sample of 13 individuals who had completed active curative treatment for colorectal cancer.ResultsStudy findings suggest that colorectal cancer survivors employ a broad range of techniques and approaches to manage adjustment to everyday life such as goal-setting, managing informal networks and adopting strategies for physical and emotional recovery. Personal interests were used to create a sense of meaning and through the cultivation of altruistic and utilitarian outlooks on life, positive emotional gains were obtained.ConclusionsColorectal cancer survivors employ personal strategies for managing life in the survivorship period following cancer treatment. The study findings demonstrate additional areas for exploration such as the effect of altruism on adjustment and the relationship to other groups of cancer survivors.     

Significant others’ lived experiences following a lung cancer trajectory - From diagnosis through and after the death of a family member

Purpose

The purpose of this study was to illuminate the meanings of significant others’ lived experiences of their situation from diagnosis through and after the death of a family member as a consequence of inoperable lung cancer.

Methods

The data was collected through narrative interviews from eleven significant others and interpreted using a phenomenological hermeneutic approach.

Keyresults

Four themes emerged: being unbalanced, being transitional, being cared for, and moving forward.

Conclusion

The significant others’ experiences can be viewed as a transition process, beginning with a sense of dislocation in life and continuing through struggling, enduring and conquering the consequences of the altered life situation until finally approaching a point characterized by a sense of stability. Different strategies of adjustment and adaptation to the new living conditions are considered. Furthermore, the results indicate the need to develop a framework for family-centered health care in order to enhance the wellbeing for the significant others both in the anticipatory grief phase and during the bereavement phase.     

Perceived barriers to physical activity for colorectal cancer survivors

Purpose  

Promoting physical activity among cancer survivors is a high priority. Understanding barriers to physical activity provides an evidence base to inform relevant strategies for doing so.     

Health behaviors of Australian colorectal cancer survivors,compared with noncancer population controls

Goal  A better understanding of health behaviors after a cancer diagnosis is important, as these behaviors are related to physical functioning, disease recurrence, development of second primary cancers, and risk of other chronic diseases. Body weight and health behaviors (smoking status, alcohol consumption, and physical activity) were examined in a population-based sample of colorectal cancer survivors and compared to a matched population group. Materials and methods  Data were collected by telephone interviews pre-diagnosis (retrospectively reported), 6 and 12 months post-diagnosis for colorectal cancer survivors (n = 1,250). Comparison data were from a population-based cancer risk survey (n = 6,277). Results  Colorectal cancer survivors were most likely to be overweight/obese pre-diagnosis (66%) than at 6 months (54%) or 12 months post-diagnosis (61%). There was little variation from 6 to 12 months in the proportion of current smokers (7% and 8%, respectively) or high-risk drinkers (both 22%). The greatest changes were for physical activity, with 53% of survivor’s sufficiently active pre-diagnosis, 32% at 6 months, and 38% at 12 months post-diagnosis. At 12 months, colorectal cancer survivors were more likely than the comparison group to be: underweight (OR = 2.14, 95% CI = 1.38–3.31); a former smoker (OR = 1.44, 95% CI = 1.26–1.63); a low-risk (OR = 1.25, 95% CI = 1.09–1.44) or high-risk drinker (OR = 1.70, 95% CI = 1.43–2.03); and insufficiently active (OR = 1.57, 95% CI = 1.34–1.83) or inactive (OR = 2.76, 95% CI = 2.39–3.19). However, colorectal cancer survivors were significantly less likely to be a current smoker (OR = 0.68, 95% CI = 0.54–0.85). Conclusions  Our findings show particular scope for physical activity interventions for colorectal cancer survivors. Improving the general health of cancer survivors should help to decrease morbidity in this population and associated health system expenditure.