Factors influencing changing bowel habits in patients undergoing sphincter-saving surgery for rectal cancer.

A research survey research was conducted to identify factors affecting changes in bowel habits of rectal cancer patients undergoing sphincter-saving surgery and to provide basic information useful in nursing interventions supporting treatment for rectal cancer patients. The subjects were rectal cancer patients who had undergone sphincter-saving surgery over 2 years ago. The final analysis included 107 patients who had made outpatient visits to the colorectal surgery from 12th to 31st May, 2014. Collected data were processed with SPSS Version 21.0. Changes in bowel habits in the subjects were observed: frequent bowel movement in 74 patients (69.2%) and faecal incontinence in 48 (44.9%). Most of the patients used self-care to improve their bowel function including dietary modification (78.5%), regular exercise (72.0%) and pelvic floor exercise (34.6%). Frequent defecation was associated with adjuvant chemoradiation therapy (P < 0.001) and faecal incontinence was associated with age of ≥65 years (P = 0.019) and a group who underwent adjuvant radiation therapy (P < 0.001). It is necessary to give sufficient information about possible postoperative changes in bowel habits to patients with the risk factors before surgery.

Prevalência de radiodermatite em pacientes com câncer de canal anal e reto e fatores de risco associados à radiodermatite severa / [Prevalence of radiodermatitis in patients with anal canal cancer and rectum and risk factors associated with severe radiodermatitis]

A radioterapia é uma modalidade importante para o tratamento do câncer e, apesar dos avanços nas técnicas de radiação, os pacientes ainda experimentam eventos adversos. A radiodermatite é definida como um conjunto de lesões cutâneas provocadas por exposição á radiação ionizante, além de ser considerada uma queimadura complexa que ocorre das estruturas internas às externas, podendo levar a complicações secundárias, como infecção. Seu desenvolvimento em pacientes com câncer de canal anal e reto é comum, sendo sua toxicidade relacionada principalmente devido à pele no campo de tratamento apresentar muitas dobras, umidade e atrito constantes, além de depender de seu estado nutricional e tratamento associado com quimioterapia. Este evento quando severo tem um impacto negativo ao tratamento pela possibilidade de falha devido às interrupções transitórias para recuperação da pele. O enfermeiro desempenha um papel importante na educação dos pacientes em tratamento de radioterapia, visto que através da consulta de enfermagem orienta o indivíduo e seus familiares nos cuidados necessários para minimizar e tratar este evento através do processo de enfermagem, onde, na avaliação de pele, o enfermeiro utiliza os critérios de graduação da radiotoxicidade aguda da Radiation Therapy Oncology Group. Em decorrência dos efeitos adversos provocados na pele, o presente estudo teve como objetivos: identificar a prevalência da radiodermatite e sua associação com fatores de risco para graus mais severos em pacientes com câncer de canal anal e reto acompanhados pela consulta de enfermagem; e analisar os impactos dos casos com graus mais severos de radiodermatite no seguimento terapêutico. Trata-se de um estudo exploratório, seccional, realizado através da análise documental de 112 prontuários de pacientes com câncer de canal anal e reto submetidos à radioterapia com indicação curativa acompanhados na consulta de enfermagem no ano de 2017. Aplicou-se formulário estruturado para a coleta de dados das variáveis no prontuário, que posteriormente foram tabulados e analisados com auxílio do softaware SPSS, empregando-se estatística analítica e descritiva. Os resultados evidenciaram que 99,1% dos pacientes apresentaram radiodermatite, sendo 34,8% radiodermatite severa. A radiodermatite severa esteve associada ao sexo, idade e tipo de aparelho. 100% dos pacientes que tiveram suspensão temporária do tratamento, apresentaram graus 3 ou 4 de radiodermatite. O estudo mostrou que graus severos de radiodermatite é uma reação adversa de alta prevalência em pacientes com câncer de canal anal e reto em tratamento com radioterapia de indicação curativa. Acredita-se que a consulta de enfermagem tem uma significativa função na prevenção de radiodermatite e diminuição da suspensão do tratamento.

Radiotherapy is an important modality for the treatment of cancer and, despite advances in radiation techniques, patients still experience adverse events. Radiodermatitis is defined as a set of cutaneous lesions caused by exposure to ionizing radiation, in addition to being considered a complex burn that occurs from internal to external structures, and may lead to secondary complications such as infection. Its development in patients with anal and rectal cancer is common, and its related toxicity is mainly due to the skin in the treatment field presenting many folds, constant moisture and friction, besides depending on its nutritional state and treatment associated with chemotherapy. This severe event has a negative impact on the treatment because of the possibility of failure due to transient interruptions to skin recovery. The nurse plays an important role in the education of patients in radiotherapy treatment, since through the nursing consultation the individual and his / her relatives are guided in the necessary care to minimize and treat this event through the nursing process, where, in the evaluation of the skin, the nurse uses the Radiation Therapy Oncology Group graded criteria for acute radiotoxicity. As a result of the adverse effects on the skin, the present study had the following objectives: to identify the prevalence of radiodermatitis and its association with risk factors for more severe degrees in patients with anal and rectum cancer, followed by the nursing consultation; and to analyze the impacts of cases with more severe degrees of radiodermatitis in the therapeutic follow-up. This is an exploratory, sectional study carried out through the documentary analysis of 112 medical records of patients with anal and rectum cancer submitted to radiotherapy with curative indication followed up at the nursing consultation in 2017. A structured form was used to collect variables data in the medical record, which were later tabulated and analyzed using the SPSS software, using analytical and descriptive statistics. The results showed that 99.1% of the patients presented radiodermatitis, 34.8% of them being severe radiodermatitis. Severe radiodermatitis was associated with gender, age and type of appliance. 100% of the patients who had temporarily suspended treatment presented grades 3 or 4 of radiodermatitis. The study was that severe degrees of radiodermatitis is a highintensity adverse reaction in patients with anal canal cancer and resumed in treatment with curative indication radiotherapy. It is believed that the nursing consultation has a significant role in the prevention of radiodermatitis and decreased suspension of treatment.

Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study.

A temporary stoma is often used in rectal cancer surgery to protect a distal anastomosis, which remains a major concern after rectal cancer surgery, particularly after low anterior resection. The temporary stoma is scheduled for closure. However, the optimal time of closure of the protecting stoma remains unclear because of sparse studies and data. We aimed to detect the efficacy between early and late temporary ileostomy closure in patients with rectal cancer during or after neoadjuvant chemoradiotherapy. We conducted a prospective, 2-group design between early and late ileostomy closure group in patients after rectal cancer surgery with temporary stoma. Participants were recruited in a teaching hospital in Guangzhou, China. A total of 161 patients confirmed diagnosis of rectal cancer underwent curative surgery and temporary ileostomy. Participants with temporary ileostomy received closure surgery after 1 (early) or 6 (late) months were assessed by clinical parameters and quality of life. Patients in late closure group received more adjuvant chemotherapy cycles but with comparable incidence of stoma closure-related complications and length of hospital stay compared to early closure group. Participants in late closure group with standardized postoperative chemotherapy might have a better prognosis compared with those in early closure group. An increased emphasis should be given to choose the optimal closure time of patients with rectal cancer having temporary ileostomy. Colorectal nurses could provide support to physician for observation of prognosis of different closure time.

Nursing implications: symptom presentation and quality of life in rectal cancer patients.

AIMS AND OBJECTIVES: To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. BACKGROUND: Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. DESIGN: A prospective, quantitative correlational design using purposive sampling was adopted. METHODS: Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. RESULTS: Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. CONCLUSION: Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. RELEVANCE TO CLINICAL PRACTICE: Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times.

Surgical treatment of low rectal cancers with APER and IGAP flap.

This article describes current treatments for individuals with a low rectal cancer. It examines the rationale for surgical treatment involving abdominoperineal excision of the anus and rectum (APER) and outlines how surgery for rectal cancer has evolved over recent years. Surgical advances mean the use of regional flaps is advocated to overcome the common problem of impaired perineal wound healing and the principles of this surgery are summarised. Postoperative nursing considerations relating to the inferior gluteal artery perforator (IGAP) flap will be discussed, as well as the importance of scrupulous wound care and patient education. The implications of this form of surgery on a patient's recovery and discharge planning are also explored.

Patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer.

AIMS AND OBJECTIVES: To investigate patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer and the relationship between bowel symptom experiences and the self-care strategies used. BACKGROUND: Earlier diagnosis of rectal cancer allows for less invasive surgical treatments such as sphincter-saving procedures to be performed. Although a permanent stoma is generally not required, patients experience changes in bowel function following this surgery. However, limited research exists on patients' bowel symptom experiences and the self-care strategies used to manage symptoms following sphincter-saving surgery of rectal cancer. DESIGN: Quantitative descriptive correlational. METHODS: A convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected (April 2010-December 2010) using the Illness Perception Questionnaires, the Difficulties of Life Scale and a researcher developed Self-care Strategy Measure. The research was underpinned by the Symptom Management Theory. FINDINGS: Relating to the four most effective self-care strategies used respondents reporting more bowel symptom were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times. Females, respondents with high timeline cyclical scores and respondents with high physiological responses scores were more likely to use protective clothing. Respondents reporting more bowel symptom and with high social responses scores were more likely to use bowel medication. Females were more likely to wear incontinence pads. CONCLUSION: This research provides insights into the daily bowel symptom experiences of patients following sphincter-saving surgery for rectal cancer. It demonstrates the range of self-care strategies that individuals use to manage their bowel symptoms and the self-care-strategies that were most effective for them. RELEVANCE TO CLINICAL PRACTICE: Patients should be encouraged to report on-going bowel problems following sphincter-saving surgery for rectal cancer. Supportive care for patients should be comprehensive and tailored to meet individual needs.

Quantifying postdischarge unmet supportive care needs of people with colorectal cancer: a clinical audit.

AIM: There are limited data concerning the unmet needs experienced by patients with colorectal cancer. The aim of this study was to identify unmet supportive care needs of people with colorectal cancer following discharge from hospital. METHOD: Health service utilization was used as a measure of expressed unmet need. A retrospective case note review was conducted of 521 patients surgically treated for colorectal cancer at Royal Prince Alfred Hospital, Sydney, between 1 January 2004 and 31 December 2007. Case notes maintained by a cancer nurse specialist were reviewed to identify postdischarge occasions-of-service where unmet need was expressed. Logistic regression was conducted to investigate predictors of unmet need. RESULTS: Of 521 patients, 219 (42%) patients had unmet supportive care needs, of which 50% of all needs was found in the physical domain. Twenty-six per cent of unmet needs was expressed within the first week following discharge from hospital after cancer surgery; however, 21% persisted after 6 months. Multivariate analysis indentified that in this cohort, younger age predicted the expression of an unmet need (AOR, 0.97; 95% CI, 0.96-0.99). People with rectal cancer remained significantly more likely to require more than one contact with the nurse to satisfy a need (AOR, 2.80; 95% CI, 1.60-5.01) and to report a physical need (AOR, 3.56; 95% CI, 2.03-6.27). CONCLUSION: This study has shown that auditing the interactions of a cancer nurse with patients can provide information about unmet supportive care needs, which can be used to develop relevant supportive care services or interventions for people with colorectal cancer.

Nurse or surgeon follow-up after rectal cancer: a randomized trial.

AIM: Follow-up programmes consume a large amount of resources with less time for the surgeon to take on new patients. The aim of this randomized study was to compare patient satisfaction, resource utilization and medical safety in patients curatively operated for rectal cancer who were followed up by either a surgeon or a nurse. METHOD: The nurse was trained by the colorectal surgeon before the start of the study. Curatively operated patients were asked to give their consent to participate. Randomization was performed by the stoma therapist. After each consultation, the patient completed a questionnaire. RESULTS: A total of 110 patients (58 men) age 68 (range 41-87) years were included between 2002 and 2005. Only three patients refused participation. Patient satisfaction was high according to the Visual Analogue Scale (VAS): 9.4 for the surgeon and 9.5 for the nurse (NS). Consultation time was longer for the nurse: 24 vs 15 min (P = 0.001), with more blood samples being taken (29%vs 7%, P = 0.002). Radiological investigations exceeding the routine were made in 11%vs 4% (NS) cases. Surgical assistance was needed in 13 of 182 consultations with the nurse [mean 6 (1-15) min, total 75 min]. Distant metastases were detected in seven patients in the surgeon group and eight in the nurse group (P = 0.953). Total costs of follow-up did not differ. CONCLUSION: Patient satisfaction was equally high for the specialist nurse as for the colorectal surgeon. On only a few occasions was surgical assistance necessary and total costs for the follow-up showed no difference. Medical safety appeared uncompromised. Nurse-led follow-up is encouraged.

Fatigue and other variables during adjuvant chemotherapy for colon and rectal cancer.

PURPOSE/OBJECTIVES: To examine patterns of fatigue and other variables (sleep quality, sleep-wake variables, activity and rest, circadian rhythms, quality of life [QOL], blood counts, and demographic and medical variables) during colon and rectal cancer adjuvant chemotherapy, as well as feasibility of the study. DESIGN: Longitudinal, descriptive feasibility study. SETTING: Two oncology clinics in the midwestern region of the United States. SAMPLE: From April 2006-December 2008, 27% of screened subjects (n = 21) enrolled and 14 completed the study. Participants were middle aged, partnered, and employed and had postsecondary education. METHODS: Measurements completed during the first week of three two-week cycles (chemotherapy 1-3) and at six weeks (before chemotherapy 4) were the Piper Fatigue Scale, Pittsburgh Sleep Quality Index, wrist actigraphy, Functional Assessment of Cancer Therapy-Colon, blood counts, and demographic and medical data form. Analysis included descriptive statistics and repeated-measures analysis of variance. MAIN RESEARCH VARIABLES: Fatigue, sleep quality, sleep-wake variables, activity-rest, circadian activity rhythms, and QOL. FINDINGS: Fatigue was mild at baseline and rose to moderate levels during chemotherapy 1-3. Sleep quality was poor the months prior to chemotherapy 1 and chemotherapy 4. Actigraphy data revealed disturbed sleep, low daytime activity, and impaired circadian activity rhythms during the first week after chemotherapy 1-3. QOL ratings were similar to those in other cancer populations. Fatigue increased, and white blood cell counts decreased significantly over time. CONCLUSIONS: During adjuvant chemotherapy, patients reported moderate fatigue and poor sleep quality; actigraphs confirmed problems with sleep maintenance as well as low daytime activity and disturbed circadian rhythms. Multiple barriers were encountered during the study. IMPLICATIONS FOR NURSING: Clinicians should screen for fatigue and sleep-wake variables and use guidelines to select interventions.

[The nursing of a lower rectal cancer patient after sphincter-preserving surgery].

The anal sphincter-preserving operation (ASP) has represented a significant improvement in surgical procedure for lower rectal cancer patients in recent years. Discussion has continued, however, on how to manage the reduced fecal function after such surgery. This case report describes how to help a patient with lower rectal cancer after ASP to overcome the problems due to changes in fecal function. Process recording was used to document the nursing process from Jan. 18 to Feb. 1, 2007. Data collected from interview, observation, and medical records, show that the patient revealed four vital nursing problems: fecal function disorder, impaired skin integrity, inappropriate regulation of diet, and powerlessness. After practicing pelvic floor exercises, adjusting her fecal behavior and modifying her food intake, the patient regained control of her fecal function and improved her quality of life.

Seating and pressure support needs of people with cancer in the cervix or rectum: a case series on the clinical usefulness of pressure mapping assessment.

Pressure sores present a challenge to people with rectal and cervical cancers due to weight loss, compromised nutrition, chemotherapy and radiotherapy. Affected individuals often experience intense pain on sitting, and prefer to spend the majority of their time lying down. This pilot study, employing a case study design, investigated the pressure care needs of such persons using pressure mapping, a technology designed to measure pressures at the seating interface. Four participants were mapped on a selection of five cushions, three of which were developed to specifically reduce midline posterior pressure/pain relief. Participants rated the cushions for comfort. Findings demonstrated an inconsistent relationship between interface pressures and perceived cushion comfort, suggesting that patient-rated comfort is a poor indicator of high interface pressures. The specialized cushions did not always meet the needs of this target population and no one cushion suited all. This study demonstrated the precarious clinical balance needed between comfort and achieving optimal pressure reduction in cushion prescription for this client group, and suggested that comfort was more important than pressure reduction in terms of their seating needs.

[Nursing care for lower rectal cancer patients undergoing anal sphincter-saving operation].

In the past, Abdominal Perineal Resection (APR) with a permanent end-sigmoid colostomy was the major operating procedure for lower rectal cancer. Colostomy seriously affects patients' physical and psychological functions. Recently, the development of surgical devices and pre-operation adjuvant treatment combined with chemoradiotherapy have made an anal sphincter-preserving (ASP) operation possible. With these new treatment procedures, both the survival and recurrence rates are improved, as is patients' quality of life. The complications associated with ASP, however, are different from those associated with APR. There is only limited discussion of these issues in the literature on the subject. This paper synthesizes the information in the literature with the authors' personal clinical experiences. We propose several nursing interventions that could be applied by clinical nurses to assist ASP patients in coping with post-operative complications.

Using the Cancer Rehabilitation Questionnaire in patients with colorectal cancer.

This article describes the development and testing of the Cancer Rehabilitation Questionnaire (CRQ) in patients with colorectal cancer. A descriptive, correlational survey was conducted in a sample of patients with colon or rectal cancer who received care at an outpatient cancer clinic at a large, northeastern U.S. academic medical center. Patients were identified from the Tumor Registry (N = 327) and received a mailed questionnaire. One hundred and three patients with colorectal cancer completed the demographic questionnaire, the CRQ developed by the investigators, and the Quality of Life Index (QLI). Significant differences were found between individuals with colon cancer and individuals with rectal cancer on the total CRQ (p < .005) and the physical, future orientation, and role-relationship subscales. For the QLI, significantly lower scores were reported on the family subscale for patients with rectal cancer in comparison with those with colon cancer. More attention to rehabilitation issues and quality of life is required across the trajectory of the cancer experience. With the increasing incidence of colorectal cancer, nurses in rehabilitation practice must address the issues affecting patients with this disease as they progress from diagnosis to treatment and rehabilitation.

Understanding denial.

PURPOSE/OBJECTIVES: To explore the adaptive and maladaptive uses of denial while developing a clearer understanding of denial. DATA SOURCES: Nursing and psychological periodicals and textbooks. DATA SYNTHESIS: Oncology nurses tend to have too broad a definition of denial because they overgeneralize similar patient responses and label them as denial. Because of the uncertainty as to its value, denial is viewed as a negative, fixed response to a crisis and can strain the nurse-patient relationship. CONCLUSION: Denial is a fluid, interpersonal experience that can affect patients during many points of the cancer experience. By experiencing a clearer understanding of denial and recognizing its adaptive value, nurses can provide more effective patient care. IMPLICATIONS FOR NURSING: Clinicians should not underestimate the value of the nurse-patient relationship when a patient is in denial. Patience, understanding, and self-awareness are crucial for providing a safe, trusting environment for patients who are experiencing denial.

Case study: managing and caring for a patient undergoing stoma formation.

A 75-year-old man had attended his GP, as he was worried that his altered bowel habits and slight rectal bleeding was more sinister than haemorrhoids. This article describes the subsequent investigations, care and treatment that he received. It highlights how early detection, prompt treatment, appropriate care and management can enable a person to cope with the devastating diagnosis of bowel cancer, surgery and the need for a stoma. This patient was otherwise well which contributed both to the treatment decision and successful outcome. Unfortunately, not all patients have such an experience, and the measures taken to prevent complications are described.