Importance of Follow-up Regime for Colorectal Cancer Survivor
Discuss about the Colorectal Cancer Case Study for Ambulatory Care.
The case study recounts the discharge and self-management plan for 65 year old, John diagnosed with colorectal cancer. Colonoscopy was performed and the reports showed positive results for cancer in the bowel. He did not experience any sort of symptoms except for occasional pain, tiredness and ticking pain strapped to his back. After that, he was referred to a surgeon for the operation and treatment of cancer of the bowel. Surgery procedure was explained to John and discussed the treatment after surgery. Therefore, the purpose of the essay is to make John and his wife understand the importance of follow-up regime to be aware of the signs and symptoms of colorectal cancer recurrence after discharge. Moreover, John also needs to know about self-care management after discharge that is important for supporting recovery and his well-being after curative colorectal cancer treatment (Jefford et al., 2013). Therefore, the following essay comprises of two main sections: discharge plan, education, and self-management along with survivorship issues that he may experience after his discharge from the hospital.
Follow-up regime is important after curative treatment of colorectal cancer as there is an increased incidence for adenomatous polyps and metachronous primary colorectal cancers with 62% and 7.7% incidence rates respectively (Siegel et al., 2012). This suggests that colonoscopic surveillance along with removal of adenomas may be helpful in reducing the incidence of second primary tumours as outlined by Clinical Practice Guidelines (CPG), Cancer Council Australia (Van Cutsem et al., 2016). Colorectal cancer follow-up regime can be beneficial in investigating pathways helpful in disease recurrence investigation (Labianca et al., 2013). Considering the case study, follow-up regime is recommended for John every three to six months up to two years with six months to year duration after the surgery. Colonoscopic, haematological and radiological evaluation is recommended for John after resection during intense follow-ups up to two years, as recurrence is asymptomatic in about 50% of cases (DeSantis et al., 2014). Follow-up for John will include sigmoidoscopy and digital examination of rectum along with CT and measurement of carcinoembryonic antigen (CEA) marker levels. CEA tests need to be bimonthly for John and it is recommended that implications of follow-up need to be determined that is based on quality of his life, tests and timing with the GP. CEA test can be helpful in investigating the amount of protein that may appear in blood in some cancers including colorectal cancer especially in Australian clinical settings (Meyerhardt et al., 2013).
Signs and Symptoms of Colorectal Cancer Recurrence
It is mandatory for John and his wife to be aware of the signs and symptoms regarding recurrence of colorectal cancer. This can occur in cases when there is recurrence of cancer if few cancer cells survive at the location of original tumour after resection and grow eventually. As a result, there is metastasis-indicating condition spreading to other parts of the body exhibiting recurrence symptoms. The signs and symptoms comprises of constipation, blood or dark stools, changes in bowel movements, tiredness and weight loss (Pettersson et al., 2014). Individual may also feel full or bloated due to gas in the stomach. Hence, regular check-ups is recommended for John up to two years after curative treatment as symptoms of recurrence does not appear until disease progression. Although, there is little evidence available regarding recurrence of colorectal cancer as cancer stage decides the recurrence chances, intense follow-ups up to two years after resection can be beneficial to detect relapse symptoms as early as possible (Emery et al., 2013).
After active treatment, cancer patients fear about the chances of relapse and spread of the disease to other parts of the body. This can result in major distress and give rise to physical psychological and social issues after curative treatment. In the case scenario, John may fear about cancer recurrence that might affect his overall health and wellness. Evidence suggests that fear of recurrence (68%), sleep difficulties (48%) and fatigues (67%) are the most prevalent challenges of colorectal cancer survivorship (Earle & Ganz, 2012). In cancer survivors like John, physical, psychosocial, emotional and survivor issues are witnessed that affects their quality of life. Pain, tiredness and fatigue are the major physical issues that are associated with curative treatment of colorectal cancer. Psychosocial issues comprises of depression, anxiety, relationship difficulties and traumatic symptoms that John may experience after the treatment (Rowland & Bellizzi, 2014). Social issues comprises of patient adjustment to the disease after treatment and effect on the family members like John’s wife, Carol. He may experience emotional trauma like unpleasant episodes of distress, hopelessness, anger or helplessness. As there are modifications in lifestyle while coping with medication side effects, it may cause survivor issues in John resulting in social exclusion. He may experience some special issues like spiritual issues like confrontations with life and death meaning having implications on his health and well-being after the treatment (Puchalski, 2012).
Self-management plan is beneficial for John to deal with the survivor issues that is experienced after curative treatment of colorectal cancer. He needs to manage his condition effectively to prevent further complications and in order to reduce the chances of recurrence after active treatment. Patient education and psychosocial interventions are required for him to address his fears about relapse and life uncertainty (Badr & Krebs, 2013). He need to be informed about the side-effects of medications, signs and symptoms of relapse and coping mechanisms that may be beneficial for addressing his fears of cancer survival. For John’s proper psychosocial, physical and emotional functioning, it is important to provide supportive care as a part of self-management plan along with patient empowerment. According to a study conducted by Ribarov, Ivanov & Ivanova, (2017) self-management in colorectal cancer helps in better management of the disease condition improving the quality of mental, physical and social life after cancer treatment. There is a positive relationship between self-management support and patient satisfaction helpful in better quality of life.
Survivorship Issues Experienced by Colorectal Cancer Survivor
Self-management strategy signifies the active engagement of the patient in treatment regime that comprises of healthy lifestyle modifications and self-care activities (Lynch, van Roekel & Vallance, 2016). Activities like healthy eating, medication compliance, active living like physical exercise interventions and regular follow-ups would help to boost his confidence and self-esteem along with fast recovery and thereby, reducing the chances of cancer relapse associated with colorectal cancer (Grimmett et al., 2015). This can be achieved through positive behavior change in collaboration with GP and other healthcare professionals. Transtheoretical model (TTM) or “stages of change” is a behavior change model that is directed towards action-oriented change that promotes positive health with better outcomes for John (Dennis et al., 2013). According to World Health Organization (WHO), poor diet and additive behaviors is strongly linked to increased risk of new cancers development and recurrence chances. It is strongly recommended that positive dietary and behavioral changes like physical activity and vegetables and fruits intake can be helpful in the maintenance of quality of life in cancer survivors after treatment completion.
Motivational interviewing through effective communication skills can be helpful in facilitating effective patient education and in addressing the survivor issues experienced by John (Spencer & Wheeler, 2016). Effective communication skills by healthcare professionals can be helpful in reducing survivor issues faced by John. Communication strategy includes conveying information about the treatment expectations and outcomes including John’s responses after the treatment. Healthcare professionals need to improve John’s understanding of treatment regimen that is vital for reducing physical and psychosocial issues faced by him in a private place along with Carol (Moore et al., 2013). Psychosocial and emotional issues arise due to lack of disease knowledge and therefore, by establishing a rapport with John can be beneficial in controlling his fear over cancer, promoting empowerment, and self-efficacy and in addressing emotional trauma experienced by him.
Communication skills should establish trust and support in John so that it alleviates the feeling of anxiety and distress faced by him. Both verbal and non-verbal communication strategies like open communication with John and his wife that would be beneficial for him to verbalize his feelings related to the disease. Non-verbal communication comprises of eyes on the patient, attentiveness, touch, active listening, empathy and smile that initiate conversations and foster a non-judgmental atmosphere for both John and healthcare professionals (Pawlikowska et al., 2012). Cultural sensitivity is also important while communicating with John as it makes him comfortable to discuss his thoughts and feelings openly with the healthcare professionals. John’s feedback on education session can be helpful for healthcare professionals to evaluate his level of understanding and identifying knowledge gaps that require further teaching (Coulter, 2012). Open-ended questions along with teach-back method can be helpful in confirming understanding of the disease and assessment of behavioural changes through follow-ups, medication compliance and symptom monitoring would be helpful in evaluating the effectiveness of patient education (Tamura-Lis, 2013).
Self-management Strategies for Colorectal Cancer Survivor
From the above case study of John, it can be concluded that follow-ups, self-care management and patient education are essential elements after curative treatment of colorectal cancer. Follow-ups help in early detection of disease relapse and in addressing the survivor issues faced by cancer patients after curative treatment. Cancer survivors fear about recurrence of the disease and stressed due to the side effects of medication and treatment. Effective communication skills including verbal and non-verbal helps healthcare professionals to establish rapport and trust with the patient helpful in improving patient satisfaction with better health outcomes. In such cases, self-care management and behavioural change through transtheoritical model of change can be beneficial in promoting self-efficacy and motivation in cancer survivors.
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