1. Nursing care of patients operated-on for CRC
Tsilimigra Despoina, RN, Msc,
Iaso General Horpital

2. Colorectal cancer
Colorectal cancer (CRC) is the second most common cause of cancer death in Europe and has wide variation in outcomes among countries.
Increasing numbers of older people are contracting the disease, and treatments for advanced stages are becoming more complex.
A growing number of survivors also require specialist support

4. Screening Colonoscopy Sigmoidoscopy Computed tomography (CT)
Biopsy and imaging/pathology reports confirm a diagnosis and the stage of the disease − like most cancers, CRC is categorized into four clinical stages according to Union for International Cancer Control(UICC) classification, from localized to the lining of the colon (stage 1) to spread to other organs (stage 4), or metastatic disease.

6. Symptoms lead to diagnosis
Change in bowel habit
Anaemia
Fatigue
Rectal bleeding and an abdominal mass.
As most patients are asymptomatic, screening is of great importance.

7. Essential aspects of the nursing role
Have a insight into each patient’s experience of their disease, treatment and side-effects.
Provide information and education to the patient and family
Be the point of contact for them- act as case managers.
Act in the best interest of the patient and their family to help coordinate the diagnosis, treatment and after-care of a person with CRC
Represent the patient’s psychosocial needs and preferences within the MDT.
ECCO Essential Requirements for Quality Cancer Care: Colorectal Cancer

8. Patient’s concerns Worry, anxiety or fear Information needs Fatigue
Constipation or diarrhea
Making plans
Pain
Sleep problems
Tingling on hands and feet
Quality of Life of colorectal cancer survivors in England (2015)

9. Nursing interventions which decrease worry
Informed consent prior to treatment
Assessment of need
Adequate information & explanation
Symptom management
Post-treatment monitoring –supported self- management
10TH ESO-EONS MASTERCLASS IN ONCOLOGY NURSING

10. Preoperative nursing interventions
Evaluate health status
Preparation before surgery
Inform
Educate

11. Postoperative surgical complications
Surgical site infection (SSI) 2-25%
BMI ≥ 30,
creation/revision/reversal of an ostomy
perioperative transfusion,
male gender
ASA Score ≥ III
wound contamination
Kirchhoff et al. Patient Safety in Surgery 2010

12. Postoperative surgical complications
Anastomotic leakage %
At least one third of the mortality after colorectal surgery is attributed to leaks.
Risk factors:
male gender (OR = 3.5).
previous abdominal surgery (OR = 2.4).
Crohn’s disease (OR = 3.3).
rectal cancer < or = 12 cm from the anal verge (OR = 5.4) .
prolonged operating time (P = 0.05 as a continuous variable and P = 0.01 when prolonged operative time was >120 min).
Kirchhoff et al. Patient Safety in Surgery 2010

13. Postoperative surgical complications
Postoperative bleeding
is a rare complication, the risk depends on the performed surgical procedure, the co-morbidities of the patient and in individual cases on an impaired clotting system
Ileus
It prolongs hospital stay, increases morbidity, and adds to treatment costs.
The pathophysiology of postoperative ileus is multifactorial.
The operating time and intraoperative blood loss are independent risk factors for a postoperative ileus .
Kirchhoff et al. Patient Safety in Surgery 2010

14. Top physical needs after treatment
Time from surgery*
Ranked concerns
3 months
9 months
15 months
24 months 1
Urinary frequency (48%)
Impotence(51%)
Impotence (47%)
Impotence (45%) 2
Urinary frequency (37%)
Urinary frequency (32%)
Urinary frequency (34%) 3
Fatigue (38%)
Fatigue (33%)
Stool frequency (24%)
Fatigue (24%) 4
Insomnia (26%)
Stool frequency (26%)
Fatigue (23%)
Stool frequency (22%) 5
Stool frequency (25%)
Flatulence (23%)
Flatulence (22%)
Flatulence (20%)
Data from ColoREctal Wellbeing (CREW) cohort study

15. Monitoring
Continuing pain that does not go away with usual painkillers, or is severe, or is persistent more than 2 weeks.
Unexplained lumps, bumps, or swellings around your scar or stoma
Unexplained change in normal bowel habit -especially if you are waking up in the night with loose stools.
Unexplained loss of appetite, weight loss or increasing abdominal girth.
Any new and unexplained bleeding from your back passage or from your stoma, or in your urine.
Unexplained shortness of breath or cough which lasts for more than a few weeks.
Bleeding or discharge from your wound site.

16. Multidisciplinary team
Establishing MDTs for colorectal cancer care can lead to more complete preoperative evaluation and higher rates of access to multimodal therapies.
MDTs can improve the quality of pathology reports, provide suitable recommendations for adjuvant chemotherapy, and increase overall survival in patients with colorectal cancer.