The beneficial effect of ST-36 (Zusanli) acupressure on postoperative gastrointestinal function in patients with colorectal cancer.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of ST-36 (Zusanli) acupressure on recovery of postoperative gastrointestinal function in patients with colorectal cancer. DESIGN: A longitudinal, randomized, controlled trial design. SETTING: An urban medical center in Taiwan. SAMPLE: 60 patients with colorectal cancer who had undergone abdominal surgery. METHODS: Patients were randomly assigned to two groups, the ST-36 acupressure group (n = 30) and a sham acupressure group (n = 30). Patients in the ST-36 group received an acupressure procedure in a three-minute cycle performed three times per day during the five days after surgery. Patients in the control group received routine postoperative care and sham acupressure. Generalized estimating equations (GEEs) were used to gauge longitudinal effects of the two groups of patients. MAIN RESEARCH VARIABLES: Frequency of bowel sounds, the time to first flatus passage, first liquid intake, solid intake, and defecation. FINDINGS: Patients who received acupressure had significantly earlier flatus passage and time to liquid intake as compared to patients in the control group. Other main variables, including the first time to solid intake and defecation, did not show significant difference between the two groups. The GEE method revealed that all patients had increasing bowel sounds over time, and the experimental group had greater improvement of bowel motility than the control group within the period of 2-3 days postoperatively. CONCLUSIONS: ST-36 acupressure was able to shorten the time to first flatus passage, oral liquid intake, and improve gastrointestinal function in patients after abdominal surgery. IMPLICATIONS FOR NURSING: ST-36 acupressure can be integrated into postoperative adjunct nursing care to assist patients' postoperative gastrointestinal function. KNOWLEDGE TRANSLATION: Few studies have explored the effectiveness of acupressure techniques on promoting bowel sounds. Evidence from this study suggests stimulation of the ST-36 acupressure point can increase bowel sound frequency for patients with colorectal cancer in the first three days after surgery. Application of this technique may improve a patient's comfort after surgery.

Disgust and behavioral avoidance in colorectal cancer screening and treatment: a systematic review and research agenda.

BACKGROUND: The emotion of disgust appears to promote psychological and behavioral avoidance, a dynamic that has significant implications in physical and psychological outcomes in colorectal cancer (CRC). Patients, caregivers, and health professionals alike are all potentially susceptible to responding with disgust and the associated avoidance. OBJECTIVE: This article aimed to review the early-stage literature related to disgust and CRC, consider the clinical implications, and suggest an appropriate research agenda. METHODS: Given limited research in this area, a systematic review of the literature was broadened to include disgust and all cancers. MEDLINE, Web of Science, SCOPUS, and ProQuest Dissertations and Theses databases were searched, with additional works sourced by reviewing citation lists and/or by contacting the lead authors. RESULTS: Nine studies were identified relating to disgust and cancer screening, and 6 related to disgust and cancer treatment. Two broad findings emerged: (1) disgust appears to be promoting aversion to (and avoidance of) CRC screening, and (2) several known elicitors of disgust are widely apparent in CRC contexts. CONCLUSIONS: Disgust likely represents a key emotional substrate for avoidance among CRC patients, caregivers, and health professionals. Further research is required to identify disgust's elicitors and effects in CRC contexts, informing interventions that target early identification of persons at risk of maladaptive outcomes. Exposure therapies and mindfulness training may be well suited to treating disgust-generated avoidance. IMPLICATIONS FOR PRACTICE: Disgust has significant implications in CRC contexts. Oncology nurses are uniquely positioned to guide clinical interventions and ultimately improve outcomes in this area.

[Therapeutic education at the heart of the patient treatment pathway]. / L'education thérapeutique au coeur du parcours de soins du patient.

The surgical treatment of bowel cancer often results in a digestive stoma, either temporary or permanent. Stoma patients must learn to live with this changed body and intestinal function. They must also adapt their lifestyle to these changes. It is in this direction which the stoma therapy nurse supports the patient.

Sociocultural differences and colorectal cancer screening among African American men and women.

PURPOSE/OBJECTIVES: To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women. DESIGN: Descriptive, cross-sectional. SETTING: A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States. SAMPLE: A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older. METHODS: Participants completed a self-administered survey. MAIN RESEARCH VARIABLES: Cultural identity, CRC beliefs, family support, and informed decision. FINDINGS: Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women. CONCLUSIONS: Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs. IMPLICATIONS FOR NURSING: To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.

What do surgical oncology staff nurses know about colorectal cancer ostomy care?

BACKGROUND: For most patients diagnosed with colorectal cancer, dealing with the adjustment and rehabilitation after treatment can be overwhelming. There is a significant need for expert educational and counseling support, especially for the patient with a new ostomy. This pilot study describes acute care oncology staff nurses' knowledge about and attitudes toward providing direct ostomy care support and education. This study is part of a larger project assessing gaps in education and services in support of patients with colorectal cancer. METHODS: The Survey on Ostomy Care questionnaire designed to assess nurses' knowledge about and attitudes toward ostomy care was administered to oncology staff nurses at a comprehensive cancer center. RESULTS: Only 30% of staff nurses surveyed strongly agreed or agreed with the statement, "I care for ostomy patients often enough to keep up my skills in ostomy care." Maintaining staff nurses' ability to teach and demonstrate to patients complex care such as ostomy care depends on the ability to practice both education and hands-on skills. Staff nurses identify that lack of opportunity to care for the new ostomy patient influences their ability to maintain skill expertise. CONCLUSION: The results show the need to explore the provision of ongoing staff education for low-volume patient populations using creative teaching strategies, such as clinical simulation and short videos.

Effect of kefir on the quality of life of patients being treated for colorectal cancer.

PURPOSE/OBJECTIVES: To determine kefir's effect on the prevention of gastrointestinal complaints and quality of life (QOL) in patients being treated for colorectal cancer. DESIGN: Randomized, controlled, prospective, interventional study. SETTING: Istanbul University Oncology Institute in Turkey. SAMPLE: 40 patients, 20 of whom were randomized to the experimental (kefir) arm and 20 who were randomized to the control arm. METHODS: Informed consent to participate in the study was obtained. Before treatment began, demographics, illness-related characteristics, complaints, and QOL of participants were evaluated. During treatment, side effects were evaluated one week after every cycle of therapy. QOL was evaluated after the third and sixth cycles of treatment. MAIN RESEARCH VARIABLES: The effect of kefir on the prevention of gastrointestinal complaints and QOL in patients being treated for colorectal cancer. FINDINGS: Following chemotherapy, the experimental (kefir) group had more treatment-related gastrointestinal complaints but a decrease in sleep disturbance. No difference was found between the two groups for QOL. CONCLUSIONS: Kefir does not prevent or decrease gastrointestinal complaints in patients undergoing chemotherapy for colorectal cancer. Kefir did decrease sleep disturbances in the experimental group. IMPLICATIONS FOR NURSING: Many patients use complementary and alternative medicine during cancer therapy. This study may provide information about the effectiveness of kefir in patients with cancer.

Outcomes in 2748 patients referred to a colorectal two-week rule clinic.

OBJECTIVE: To assess the 3-year outcomes of a nurse-led, one-stop, 2-week rule (TWR) clinic for suspected colorectal cancer (CRC) in a large teaching hospital. METHOD: Data were collected prospectively from January 2002 to December 2004. In total, 2748 patients were seen over the 3-year period. The ratio of male:female subjects was 1190:1558 (43%:57%). Median age at presentation was 66 years (range 17-96). RESULTS: A total of 1363 (49.6%) nonconforming referrals were made; 1300 patients (47.3%) underwent flexible sigmoidoscopy during their initial assessment in clinic; 1439 patients (52.4%) underwent a barium enema during the course of their investigation; 2503 patients (91.1%) were seen within 14 working days. The median overall wait for the initial clinic appointment was 10 days. The annual number of patients seen was similar over the 3-year period. A total of 174 cancers (6.3%) were identified which accounted for 36.4% of all CRCs diagnosed during the study period. Nineteen cancers presented in the nonconforming group (1.6% of all non-conforming patients). Rectal tumours accounted for 59.8% (n = 104) of all cancers diagnosed while right-sided tumours accounted for only 10.9% (n = 19). Advanced tumours accounted for 73.0% (n = 127) of the total; 133 (76.4%) cancer patients underwent some form of surgical intervention. CONCLUSION: A specialist nurse-led, one-stop TWR clinic for suspected colorectal cancer is sustainable and can be run successfully with over 90% of referrals seen within the targeted time period. The proportion of non-conforming referrals was high and a large number of advanced and unstaged tumours was observed. Low numbers of proximal tumours were detected.

Ostomy care and rehabilitation in colorectal cancer.

OBJECTIVES: To review ostomy care in colorectal cancer, current trends in assessment, management, and treatment, and the role of the enterostomal therapy (ET) nurse in cancer care. DATA SOURCES: Published literature and the author's clinical experiences in ostomy wound care. CONCLUSION: Care of the patient with colorectal cancer requiring an ostomy involves both physical and psychological rehabilitation. The education and skills of an ET/wound, ostomy, and continence (WOC) nurse can provide a valuable service to the patient/family, surgeon, oncology nurse, and other health care providers. IMPLICATIONS FOR ONCOLOGY NURSES: An ostomy is not a handicapping procedure. Living well with a colostomy can be achieved through proper patient preparation, education, and planning. Provision of individualized comprehensive care facilitates physical and psychological rehabilitation.

Capecitabine: a new adjuvant option for colorectal cancer.

Colorectal cancer continues to pose a major public health threat in the United States. Without postsurgical adjuvant therapy, approximately 50% of patients will have recurrent disease and die within five years. Since 1990, five new chemotherapy agents have been added to the therapeutic armamentarium for management of colorectal cancer, and agents traditionally used to treat metastatic and advanced disease increasingly are being applied in the adjuvant setting. One such treatment, capecitabine, offers patients the benefit of oral dosing and permits at-home self-management. A phase III randomized trial, Xeloda in Adjuvant Colorectal Cancer Treatment, demonstrated that treatment with single-agent capecitabine was equivalent to bolus 5-fluorouracil with leucovorin with respect to disease-free survival and overall survival, with significantly less diarrhea, stomatitis, neutropenia, nausea and vomiting, and alopecia. This article reviews the findings and discusses how oncology nurses can help provide effective education and monitoring for patients using oral treatment in the adjuvant setting.

Implementation of capecitabine (Xeloda) into a cancer centre: UK experience.

Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.

Spirituality and life-threatening illness: a phenomenologic study.

PURPOSE/OBJECTIVES: To examine the lived experience of individuals when confronted with a life-threatening disease. RESEARCH APPROACH: Qualitative, phenomenologic using Giorgi's approach. SETTING: Patients' homes in the Midwest. PARTICIPANTS: Five women and two men, aged 44-74 years, who had a variety of diagnoses, including breast cancer, colorectal cancer, prostate cancer, pulmonary fibrosis, and myocardial infarction. METHODOLOGIC APPROACH: Subjects were recruited through flyers posted at support groups and religious establishments and by word of mouth. MAIN RESEARCH VARIABLES: Willingness to volunteer to share their stories. FINDINGS: Participants described how their spirituality provided comfort throughout their journey, strength in facing the life-threatening illness, many blessings despite the hardship of the illness, and trust in a higher power to see them through the journey. All participants described a sense of meaning in their lives throughout their experience. CONCLUSIONS: Spirituality greatly affected patients' journeys through a life-threatening illness and provided a sense of meaning despite the illness. INTERPRETATION: Nurses need to acknowledge patients' spirituality and, in turn, assist patients in meeting their spiritual needs. By understanding the study participants' experiences, nurses can better support their patients, provide time and space for spiritual practices, and honor patients' spiritual journeys.

Answering patients' needs: oral alternatives to intravenous therapy.

Metastatic colorectal cancer has traditionally been treated with i.v. 5-fluorouracil (5-FU), with or without leucovorin (LV). 5-FU is administered as either an i.v. bolus or a protracted infusion. Although schedules using the latter method offer efficacy benefits (objective response rate, time to disease progression), protracted infusion schedules are often associated with medical complications, inconvenience, high costs, and poor quality of life. Issues such as quality of life and convenience have influenced treatment decisions, but the availability of oral fluoropyrimidines represents a new development in this domain. Studies have confirmed that the majority of patients prefer oral to i.v. chemotherapy. Questionnaire-based studies have also demonstrated a preference for home-based rather than hospital-/clinic-based therapy. This preference was one of the driving forces behind the development of the oral fluoropyrimidines capecitabine (Xeloda) and uracil plus tegafur (UFT). Oral agents offer patients a more convenient treatment option that can be administered at home, providing patients with a greater sense of control over their therapy, while avoiding the medical complications and psychological distress associated with venous access. This article highlights some of the problems associated with i.v. therapy and reviews the available data on patient preference, including results of a recent, randomized, phase II study. It also provides a critical evaluation of the efficacy and safety profiles of the only two oral fluoropyrimidines approved for prescription, capecitabine and UFT/LV (UFT/LV not available in Germany and the U.S.), compared with those of two infused, 5-FU-based regimens. Finally, the results of an interactive debate exploring the opinions of approximately 400 oncologists on the issues of oral versus i.v. therapy are presented.

The role of the gastroenterology nurse in colorectal cancer screening.

This article provides an overview of the incidence of colorectal cancer in the United States and describes personal and familial factors that increase a person's risk for developing colorectal cancer. Recommendations for each classification of patient risk group are outlined. An in depth review of screening justification for colorectal cancer is presented as well as the American Cancer Society's recommendations for screening. Descriptions of and recommended frequency for fecal occult blood tests, flexible sigmoidoscopy, double contrast barium enema, and colonoscopy are explained as well as the advantages and disadvantages of each test. The role and fundamental responsibilities of the nurse endoscopist are presented based on the author's personal experience. Factors that influence patient compliance are also described, including the role of the gastroenterology nurse in facilitating colorectal cancer screening.

Spiritual assessment across the cancer trajectory: methods and reflections.

OBJECTIVES: To provide information about spiritual assessment strategies and the spiritual stages through which persons with cancer pass. DATA SOURCES: Books and articles (including research reports) from various disciplines including nursing, medicine, theology, and other health care professions: personal narratives and reflections of individuals with cancer. CONCLUSION: Sound spiritual assessment is prerequisite for sound spiritual intervention. Nurses must find the time, means, and knowledge to incorporate spiritual assessment into nursing care. Patients agree. IMPLICATIONS FOR NURSING PRACTICE: Nurses can improve spiritual assessment by eliciting patient accounts of the evolving spiritual journey and prayers that parallel changes in health status.