Survivorship Care Plan – Colorectal Cancer

Task Description and Case Study Resources

This Essay is based on an EdCaN Case Study on Colorectal cancer . You are the Cancer Care Coordinator at the hospital where John receives his adjuvant chemotherapy for colorectal cancer. John is currently receiving his last cycle of chemotherapy and you will be meeting with him to provide education with regards to his discharge and self-management planning following the end of his active treatment.

Discuss the content you would include in a Survivorship Care Plan, and outline your approaches to education and collaboration with John and his wife to develop this plan. Your plan should consider:

  • The recommended follow up regimen after curative treatment for
    colorectal cancer, having critically reviewed the available evidence.
  • Signs and symptoms associated with colorectal cancer recurrence.
  • Strategies to prevent survivorship issues that John may experience
    across all domains of health (including physical, psychological, social
    and spiritual health) after treatment for colorectal cancer.
  • Evidence-based communication strategies and theories of behaviour
    change to facilitate effective education about health behaviours and
    promote a healthier lifestyle.

Survivorship Care Plan For John A Colorectal Cancer Patient

Introduction

Colorectal cancer is one of the most common malignant diseases in the world (Seagel, DeSantis & Jemal, 2014). The risk for the development of the disease increases with age and for many years its prognosis remained poor. However, with developments in such advances as early detection, surgical treatment and adjuvant chemotherapy regimens, the survival rate beyond 5 years has increased (Seagel et al., 2017). It has therefore become paramount that post-treatment issues are addressed and this has led to the development of survivorship care plans and elaborate discharge protocols and patient education. This paper focuses on the survivorship care plan for 65-year-old John who is a survivor of colorectal cancer.

Discharge Planning

Mr. John is a 65 year old male who has been suffering from colorectal cancer. He was specifically diagnosed with a poorly differentiated adenocarcinoma infiltrating the serosa.  Mr. John had surgery of the colon as a treatment option to remove the section that had been adversely affected by the cancer. The surgery was specifically for high anterior resection for the tumour that had been found during a colonoscopy. After a recommendation by the multidisciplinary team that John receives adjuvant chemotherapy regimen, the patient agreed to it following a through deliberation between him and the caregivers. The treatment that he has been on consist of the following: Calcium folinate  (Leucovorin) 50mg IV administered on day 1, Fluorouracil 400mg/m² IV administered on Day 1, Fluorouracil 2400mg/m² by IV infusion over 46 hours that commenced on day 1. The frequency of these adjuvant therapies was after every 14 days and has been given for 12 cycles.

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Considering that there exists a risk of recurrence of colorectal cancer as well as development of other kinds of tumor after the treatment of colorectal cancer, it is important to discuss with the patient the recommended follow up regimen after the curative treatment that he has had. It would be important that I inform John and his wife of the kind of post-treatment surveillance screening that include carcinoembryonic antigen (CEA) test, pelvic CT, periodic abdominal and chest CT scans. The CEA test is significant for diagnosis of rectum and colon cancers while the mentioned scans are for detection of metastatic cancers to the respective regions (Schreuders et al., 2015). These tests would be occasionally done in order to detect second primary tumors and/or detect colorectal cancer recurrence (Rex et al., 2017). It has been found that the incidence for the adenomatous polyps and metachronous primary colorectal cancers four years post-curative surgery to be about 60 percent and 8 percent respectively (Jayesekara et al., 2017). A third of those who receive curative surgery for colorectal cancer normally die to recurrence of the disease. It is therefore significant that there be tests to detect recurrence early when they can be handled.

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I would also inform John and his wife of the signs and symptoms associated with colorectal cancer recurrence. These include back and pelvic pain, diarrhea, and constipation and belly pain (Vega, Valentin & Cubiella, 2015). The patient could also experience malaise, lack of appetite and difficulty in breathing. The patient should also look out for any sudden and unexplained weight, especially one that lasts for more than 6 months (Meyerhardt et al., 2017). Finally, it would be important to remind the patient of the essence of carrying with them their medical records whenever visiting a general practitioner for checkups as this helps in coordinating the continued management of the patient.

Collaborative approaches to education and planning for self-management

Colorectal cancer survivors face concerns that traverse spiritual, social, psychological as well as physical. There are many effects associated with the management of colorectal cancer and these are categorized into late effects and long-term effects of treatment. It is therefore significant that there be an elaborate communication and coordination of care that the patient can provide to themselves as well as those that take care of them at home and the clinical caregivers at the hospital. In this case, it would be significant to handle some of these issues concerning Mr. John and also involve her wife in the entire elaboration in order to empower her to fully participate in her husband’s post-treatment care.

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Physical issues that may confront the patient include the development of lymphedema, which is one of the most common presentations that occur long after the treatment of colorectal cancer has occurred (Stanton, Rowland & Ganz, 2015). Surgery may lead to the disruption of flow of lymph through formation of scars in the lymphatic system. Chemotherapeautic agents also predispose to the same condition (Stanton, Rowland & Ganz, 2015). Lymphedema develops very late after these events and therefore the patient should be informed about them. Another issue of concern is reduced function due to frequent feeling of fatigue which may last upto three months after treatment of cancer. The best way to prevent and reduce the effects of fatigue is to reduce activity level and only engage in light duties. Lymphedema can be prevented by the patient through taking part in regular light exercises.

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Psychological issues that I will address with John include possible concerns about his body image and appearance. There exist concerns and challenges regarding appearance and body image after the rigorous chemotherapy and its consequence on the body such as reduced body size and hair loss (Santin et al., 2015). These concerns could be there from the time during the treatment or others may set in during the post-treatment period. To prevent these concerns from affect John, I would advise him to visit a psychologist who may help him to recover confidence in himself and appreciate that his appearance post-treatment is a worthy sacrifice that had to be incurred if he was to be healed from cancer.

The main social issue that I would touch on while discussing with John would be about his financial concerns. Cancer treatment and the monitoring that occur after treatment is a costly affair financially and may take a toll on a person’s capital which may reduce their contribution to their families (Ramsey et al., 2016). This could be a major cause for distress and personal esteem. I would advise Mr. John to consider acquiring an elaborate insurance scheme that would be able to help him take care of his financial concerns.

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Spiritual concerns that could confront Mr. John include the fear of recurrence of the colorectal cancer as well as the risk of development of new primary tumors of the colon (Jeffery et al., 2016). Talking with the patient about this issue is significant in allowing the patient to appreciate the spectrum of the disease and the risk that he faces going forward. It has been shown that psychological preparation contributes a lot towards the patient’s health and the care post-treatment. Given that John is above 60 years and had been diagnosed with a poorly differentiated adenocarcinoma infiltrating the serosa, he is at a high risk of experiencing recurrence and therefore this knowledge is important to him. Included in this context would be the signs and symptoms of recurrence as well as for the development of new primary tumors in order to enable the patient and the wife to note them when they occur. The preventive measure would be to insist to the patient on the need for frequent and regular checkups which would serve to give him reassurances and therefore reduce his fears.

Mr. John would require an elaborate health education that would enable him to continue to recover and also to help him reduce the risk of recurrence or for development of new primary tumors of the colon and rectum (Senore et al., 2015). The education provided would focus on how he would take care of himself as far as such factors as diet and physical activity are concerned (Baenas & Salinas, 2015). This information would be shared with him and his wife Carol because she is an integral caregiver in the health of her husband. I would advise that he avoids red and processed meat because they are associated with increased risk for the development of colorectal cancer (Bouvard et al., 2015). This therefore means that they could predispose John to the recurrence of colorectal cancer, development of new primary colon tumors or metastasis to distant areas. I would also advice that the patient increases his body activity in order to improve on his avoidance of insulin resistance as part of a lifestyle change (Li et al., 2016). Insulin resistance is associated with increased insulin in blood, which increases risk of tumor development. It also induces and increases the activity of insulin-like growth factors (IGFs) which promote the growth of cancer cells (Sanchez-Lopez et al., 2016). The patient should also avoid cigarette smoking as this affects blood vessels and thus inhibiting optimal healing from colorectal cancer. Cigarette smoking is also associated with increased risk for the development of cancers, including colorectal cancer.

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Communication strategies are important especially when it comes to addressing survivorship issues in cancer patients post-treatment. One of the communication strategies would involve employing motivational interviewing. The patient in this case would require a lot of motivation in order to adhere to the necessary follow up therapy and screenings. This type of interview helps the patient hear themselves while they express their commitment to the agreed regimen and hence enhances their motivation to act on these commitments (Miller et al., 2017). I would also employ trans-theoretical model of change to enhance the patient’s commitment to change their lifestyle (Magnan & McCaul, 2019). The intention of the post-treatment survivorship plan is to ensure that the patient develops and maintains a healthy routine that includes avoidance of risk factors that predispose to cancer such as smoking, developing a good cancer screening routine as well as close monitoring of any signs that may indicate recurrence of colorectal cancer. The maintenance stage of the trans-theoretical model is the most significant stage as it allows patients to adhere to a given lifestyle that is beneficial to their health (Magnan & McCaul, 2019).

Conclusion

From the case study and the elaboration provided above, it is clear that proper survivorship care plans are integral in taking care of survivors of colorectal cancer. Discharge planning captures the patient’s diagnosis and the treatment that they have received. This is important for future references and in the coordination of the patient’s care. Collaborative approaches to the patient’s care helps to bring everyone concerned on board as well as address all the areas of concern as regards the patient’s health. All these are important measures and help to cater for such issues as risk of recurrence of the disease and the impact the disease has on the overall well-being of individual and social life.

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