21 Coping with Colorectal Cancer

Introduction

Hearing the words “you have cancer” can be devastating for anyone. The good news about colorectal cancer is that 80% to 90% of those diagnosed at stage I or stage II survive more than 5 years. However, when the cancer is diagnosed at stage III, only about 60% to 70% survive more than 5 years. Unfortunately, when cancer is diagnosed at stage IV, only 8.5% reach the 5-year survival milestone. Thanks to advances in the treatment of advanced colorectal cancer and better management of complications associated with disease and therapy, though, patients with this diagnosis are living longer and better, which creates a realistic sense of hope for the future among this patient population.¹

It is important to realize that the key to survival is early detection and the key to prevention is screening.

Physical and Psychosocial Aspects of Colorectal Cancer

Colorectal cancer is one of the most common invasive cancers. It is responsible for considerable physical and psychosocial morbidity.² As part of the study entitled Dimensions of Quality of Life and Psychosocial Variables Most Salient to Colorectal Cancer Patients, a number of focus group participants spoke at length about how they had coped with the experience of colorectal cancer. Some participants said they had made themselves determined to recover and felt that having a positive attitude had been helpful.² Patients who had coped with previous traumatic events were able to draw on the strength and coping abilities learned earlier through their experience with cancer.² Participants also found that talking openly about their disease and the treatment they had undergone had been helpful. Learning to live with cancer seems to involve both accepting the situation and finding the inner resources to cope.

Another study, Reducing the Unmet Needs of Patients with Colorectal Cancer: A Feasibility Study of The Pathfinder Volunteer Program, discovered that the most common needs of patients concerned the fear of cancer’s spreading or returning, the worries of others, changes in weight, changes in bowel habits or bowel movements, and bowel problems such as diarrhea, constipation, and pain.³

Patients who are facing life with a colostomy or ileostomy after surgery have serious concerns about how to deal with this situation—both physically and emotionally. It is important to remind such patients that their ostomy is allowing them to survive colorectal cancer and to be able to resume their lives.⁴ Whether a patient needs an ostomy depends on the extent of the surgery. This discussion should occur with the patient before surgery, and the patient should meet with an ostomy nurse before surgery to familiarize him- or herself with the stoma and with living with an ostomy. Furthermore, the patient should become familiar with the appearance and location of the stoma, the various ostomy appliances and supplies, two-piece pouch versus one-piece pouch or pouch plate, how to care for the ostomy, how to clean the stoma as well as the skin, the different skin barriers and seals, how to empty the pouch, how to discard the waste, how to attach and reattach the pouch, how to handle the odor as well as the noises and other sensations, and finally how to resume activities.⁴ This orientation, for the care of the stoma, may be better handled in the postoperative period once the patient has an ostomy and can really perform the daily care. Patients often find that living with a stoma is easier than they had imagined; reassurance and practical advice are key to a patient’s comfort and acceptance of the situation.

It is normal for a patient who has just received a diagnosis of colorectal cancer to feel overwhelmed and stressed. Uncertainty about the future and financial concerns can trigger a number of reactions, including grief. Patients may have trouble sleeping at night, experience body aches and headaches, and just feel exhausted. All are common symptoms of stress. However, there are strategies you can suggest to your patients to help them feel better.

Supportive Strategies

There are many ways to cope with the stress and fear associated with cancer. With education and supportive care, patients should be able to deal with the diagnosis and treatment of their cancer. However, patients who are having intense trouble coping may need more extensive counseling.

The most important advice you can give to your patients is for them to seek help as soon as they feel less able to cope with their cancer. Taking action early enables them to understand and deal with the many effects of their illness. Learning to manage stress helps them maintain a positive physical, emotional, and spiritual outlook on life.

When a patient is facing cancer, stress can build up and affect how he or she feels about life. Prolonged stress can lead to frustration, anger, hopelessness, and, at times, depression. The person with cancer is not the only one affected. Family members also are influenced by the ongoing health changes of a loved one with cancer.

The following tips help patients reduce stress:

Keep a positive attitude.

Accept that there are events you cannot control.

Be assertive rather than aggressive. “Assert” your feelings, opinions, or beliefs rather than becoming angry, combative, or passive.

Learn to relax.

Exercise regularly. Your body can fight stress better when you are physically fit.

Eat well-balanced meals.

Rest and sleep. Your body needs time to recover from stressful events.

Don’t rely on alcohol or drugs to reduce stress.

Furthermore, patients can perform a number of relaxation exercises. These exercises include specific types of breathing, muscle and mind relaxation, relaxation to music, and biofeedback. First, be sure your patient has a quiet, distraction-free location and that he or she can find a comfortable body position (i.e., sitting or reclining on a chair or sofa). Also, suggest that he or she maintain a positive state of mind and try to block out worries and troubling thoughts. The following are suggestions for stress-relieving exercises for patients.

Two-minute relaxation. Concentrate your thoughts on yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body, noticing areas that feel tense or cramped. Loosen up these areas, letting go of as much tension as possible. Rotate your head in a smooth, circular motion once or twice. (If any movement causes pain, stop immediately.) Roll your shoulders forward and backward several times. Relax all your muscles. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should now feel relaxed.

Mind relaxation. Close your eyes. Breathe normally through your nose. As you exhale, silently, say to yourself the word “one,” a short word such as “peaceful,” or a short phrase such as “I feel quiet.” Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady.

Deep-breathing relaxation. Imagine a spot just below your navel. Breathe into that spot and fill your stomach with air. Let the air fill from the stomach up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.

In addition to experiencing emotional distress, colorectal cancer patients experience physical side effects from treatment (surgery, radiation therapy, and chemotherapy). Therefore, it is important for health care providers to address both their emotional and physical concerns.

Perspective and Concerns of the Patient

Sexuality-related Issues

A study entitled Colorectal Cancer Patients’ Informational Needs about Sexuality-Related Issues identified and described the importance of providing patients with information about sexuality-related issues during hospitalization.⁵ Of the 87 patients who completed the structural questionnaire, 71% reported that their disease or its treatment had affected their sexuality. Effects on sexuality were reported by 77% of men and 64% of women with colorectal cancer. In addition, 75% of respondents younger than 40 and 67% of respondents older than 50 complained about the effect that colorectal cancer has had on their sexuality.⁵ Of the total surveyed, 72% stated that it is necessary to discuss the effect of the disease and its treatment on sexuality during hospitalization,⁵ and 87% of the patients felt that health care personnel should take the initiative in discussing sexuality-related issues. Only 12% said the initiative should come from the patient.

It is important for health care professionals to provide colorectal cancer patients with an opportunity to discuss issues related to sexuality. The clinician should develop, introduce, and evaluate action models to facilitate open discussion for these sensitive issues.⁵