Scope of the Problem
The experience of being diagnosed with advanced or progressive colorectal cancer (CRC) can be accompanied by multiple physical, emotional, psychosocial and spiritual issues. While the incidence and mortality of CRC in the United States has been declining, greater than 60% of those with CRC are diagnosed with regional or distant disease (Siegel, 2011). This percentage can vary dependent on geographical location. In countries outside of the United States the diagnosis of CRC can be delayed due to underfunding of cancer screening and care. Sierko and colleagues (2011) identified that the emotional and psychological needs of patients in Poland with an advanced stage CRC diagnosis had not been emphasized pre-1990. Since then, the political and economic climate in Poland has been transitioning, allowing for increased access to information and health services.
In order to assess the psychological, physical and social needs of patients with advanced stage CRC in Poland undergoing cytotoxic treatment, a descriptive, quantitative study was performed (Sierko, 2011). In this single institution study, a questionnaire containing closed-ended questions regarding physical, emotional, social and personal information was distributed to 50 patients with advanced CRC. The questionnaires were distributed to patients at their third or fourth chemotherapy treatment. The chemotherapy regimens were administered during a five- to seven-day inpatient hospitalization; 5-fluorouracil and calcium leucovorin were administered during the first five days.
- Asthenia, ageusia (loss of taste), nausea and diarrhea were the top four most often reported complaints
- Greater than half the patients were unable to work
- Chemotherapy administration made professional work difficult for 34% of patients and severely complicated professional work for 40% of patients
- Thirty-six percent of patients reported financial issues
- Fifty percent of patients did not keep their diagnosis from anyone while 25% were reluctant to share information about their illness with coworkers
- Seventy-four percent of patients told friends about their diagnosis and 96% shared their diagnosis and progression with their family
- Only 6% of patients had an absolute need for caregiver help during chemotherapy while 67% needed partial assistance
- Eighteen participants (36%) felt as though they received compassion from family members while the majority (62%) experienced empathy
- The family unit provided the majority of emotional support for 90% of the patients. To a lesser degree, patients received support from friends, doctors and nurses at 28%, 24% and 22% respectively and only 10% experienced support from clergy and other patients
- Education regarding treatment goals, prophylaxis and treatment of side effects by nurses resulted in complete elimination of fear of cytotoxic treatment in 62% of patients and reduced fear in 32% of patients
The multifaceted aspects of patients undergoing treatment for advanced stage CRC can be complex. Although the data in this quantitative study are specific to patients with advanced CRC in Poland, the results provide an invaluable regional view of the experience. While nurses had an integral role in minimizing the patients’ fear of cytotoxic chemotherapy, they were the least likely (22%) to provide emotional support. Similar to the patient experience in the United States, there is a significant role for caregivers and family during the cancer treatment trajectory. It would be intriguing to conduct this study in other geographic locations within and outside the United States in order to identify trends and gaps in the cancer experience for the patient with advanced CRC.
Siegel, R., Ward, E., Brawley, O., & Jemal. A. (2011). Cancer statistics, 2011. CA: A Cancer Journal for Clinicians, 61, 212-236. doi:10.3322/caac.20121 Link to free full-text http://caonline.amcancersoc.org/cgi/content/full/61/4/212
Sierko, E., Werpachowska, M.T., Wojtukiewicz, M.Z. (2011). Psychological, physical, and social situation of Polish patients with colorectal cancer undergoing first-line palliative chemotherapy. Oncology Nursing Forum, 38, E253-E259. doi: 10.1188/11.ONF.E253-E259 Link to abstract http://ons.metapress.com/content/167347810n15j525/