Colorectal Cancer Case Study: Discharge Plan, Education, and Self-Management

This case study discusses the importance of follow-up regime and self-care management for colorectal cancer patients after discharge. It also covers survivorship issues that may arise after treatment. The essay includes recommendations for follow-up regime, signs and symptoms of recurrence, and self-management strategies.

Running head: COLORECTAL CANCER CASE STUDY
Colorectal cancer case study
Name of the Student
Name of the University
Author note

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The case study recounts the discharge and self-management plan for 65 year old, John
diagnosed with colorectal cancer. Colonoscopy was performed and the reports showed positive
results for cancer in the bowel. He did not experience any sort of symptoms except for
occasional pain, tiredness and ticking pain strapped to his back. After that, he was referred to a
surgeon for the operation and treatment of cancer of the bowel. Surgery procedure was explained
to John and discussed the treatment after surgery. Therefore, the purpose of the essay is to make
John and his wife understand the importance of follow-up regime to be aware of the signs and
symptoms of colorectal cancer recurrence after discharge. Moreover, John also needs to know
about self-care management after discharge that is important for supporting recovery and his
well-being after curative colorectal cancer treatment (Jefford et al., 2013). Therefore, the
following essay comprises of two main sections: discharge plan, education, and self-management
along with survivorship issues that he may experience after his discharge from the hospital.
Follow-up regime is important after curative treatment of colorectal cancer as there is an
increased incidence for adenomatous polyps and metachronous primary colorectal cancers with
62% and 7.7% incidence rates respectively (Siegel et al., 2012). This suggests that colonoscopic
surveillance along with removal of adenomas may be helpful in reducing the incidence of second
primary tumours as outlined by Clinical Practice Guidelines (CPG), Cancer Council Australia
(Van Cutsem et al., 2016). Colorectal cancer follow-up regime can be beneficial in investigating
pathways helpful in disease recurrence investigation (Labianca et al., 2013). Considering the
case study, follow-up regime is recommended for John every three to six months up to two years
with six months to year duration after the surgery. Colonoscopic, haematological and
radiological evaluation is recommended for John after resection during intense follow-ups up to
two years, as recurrence is asymptomatic in about 50% of cases (DeSantis et al., 2014). Follow-

2COLORECTAL CANCER CASE STUDY
up for John will include sigmoidoscopy and digital examination of rectum along with CT and
measurement of carcinoembryonic antigen (CEA) marker levels. CEA tests need to be bimonthly
for John and it is recommended that implications of follow-up need to be determined that is
based on quality of his life, tests and timing with the GP. CEA test can be helpful in investigating
the amount of protein that may appear in blood in some cancers including colorectal cancer
especially in Australian clinical settings (Meyerhardt et al., 2013).
It is mandatory for John and his wife to be aware of the signs and symptoms regarding
recurrence of colorectal cancer. This can occur in cases when there is recurrence of cancer if few
cancer cells survive at the location of original tumour after resection and grow eventually. As a
result, there is metastasis-indicating condition spreading to other parts of the body exhibiting
recurrence symptoms. The signs and symptoms comprises of constipation, blood or dark stools,
changes in bowel movements, tiredness and weight loss (Pettersson et al., 2014). Individual may
also feel full or bloated due to gas in the stomach. Hence, regular check-ups is recommended for
John up to two years after curative treatment as symptoms of recurrence does not appear until
disease progression. Although, there is little evidence available regarding recurrence of
colorectal cancer as cancer stage decides the recurrence chances, intense follow-ups up to two
years after resection can be beneficial to detect relapse symptoms as early as possible (Emery et
al., 2013).
After active treatment, cancer patients fear about the chances of relapse and spread of the
disease to other parts of the body. This can result in major distress and give rise to physical
psychological and social issues after curative treatment. In the case scenario, John may fear
about cancer recurrence that might affect his overall health and wellness. Evidence suggests that
fear of recurrence (68%), sleep difficulties (48%) and fatigues (67%) are the most prevalent

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challenges of colorectal cancer survivorship (Earle & Ganz, 2012). In cancer survivors like John,
physical, psychosocial, emotional and survivor issues are witnessed that affects their quality of
life. Pain, tiredness and fatigue are the major physical issues that are associated with curative
treatment of colorectal cancer. Psychosocial issues comprises of depression, anxiety,
relationship difficulties and traumatic symptoms that John may experience after the treatment
(Rowland & Bellizzi, 2014). Social issues comprises of patient adjustment to the disease after
treatment and effect on the family members like John’s wife, Carol. He may experience
emotional trauma like unpleasant episodes of distress, hopelessness, anger or helplessness. As
there are modifications in lifestyle while coping with medication side effects, it may cause
survivor issues in John resulting in social exclusion. He may experience some special issues like
spiritual issues like confrontations with life and death meaning having implications on his health
and well-being after the treatment (Puchalski, 2012).
Self-management plan is beneficial for John to deal with the survivor issues that is
experienced after curative treatment of colorectal cancer. He needs to manage his condition
effectively to prevent further complications and in order to reduce the chances of recurrence after
active treatment. Patient education and psychosocial interventions are required for him to address
his fears about relapse and life uncertainty (Badr & Krebs, 2013). He need to be informed about
the side-effects of medications, signs and symptoms of relapse and coping mechanisms that may
be beneficial for addressing his fears of cancer survival. For John’s proper psychosocial, physical
and emotional functioning, it is important to provide supportive care as a part of self-
management plan along with patient empowerment. According to a study conducted by Ribarov,
Ivanov & Ivanova, (2017) self-management in colorectal cancer helps in better management of
the disease condition improving the quality of mental, physical and social life after cancer

4COLORECTAL CANCER CASE STUDY
treatment. There is a positive relationship between self-management support and patient
satisfaction helpful in better quality of life.
Self-management strategy signifies the active engagement of the patient in treatment
regime that comprises of healthy lifestyle modifications and self-care activities (Lynch, van
Roekel & Vallance, 2016). Activities like healthy eating, medication compliance, active living
like physical exercise interventions and regular follow-ups would help to boost his confidence
and self-esteem along with fast recovery and thereby, reducing the chances of cancer relapse
associated with colorectal cancer (Grimmett et al., 2015). This can be achieved through positive
behavior change in collaboration with GP and other healthcare professionals. Transtheoretical
model (TTM) or “stages of change” is a behavior change model that is directed towards action-
oriented change that promotes positive health with better outcomes for John (Dennis et al.,
2013). According to World Health Organization (WHO), poor diet and additive behaviors is
strongly linked to increased risk of new cancers development and recurrence chances. It is
strongly recommended that positive dietary and behavioral changes like physical activity and
vegetables and fruits intake can be helpful in the maintenance of quality of life in cancer
survivors after treatment completion.
Motivational interviewing through effective communication skills can be helpful in
facilitating effective patient education and in addressing the survivor issues experienced by John
(Spencer & Wheeler, 2016). Effective communication skills by healthcare professionals can be
helpful in reducing survivor issues faced by John. Communication strategy includes conveying
information about the treatment expectations and outcomes including John’s responses after the
treatment. Healthcare professionals need to improve John’s understanding of treatment regimen
that is vital for reducing physical and psychosocial issues faced by him in a private place along

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with Carol (Moore et al., 2013). Psychosocial and emotional issues arise due to lack of disease
knowledge and therefore, by establishing a rapport with John can be beneficial in controlling his
fear over cancer, promoting empowerment, and self-efficacy and in addressing emotional trauma
experienced by him.
Communication skills should establish trust and support in John so that it alleviates the
feeling of anxiety and distress faced by him. Both verbal and non-verbal communication
strategies like open communication with John and his wife that would be beneficial for him to
verbalize his feelings related to the disease. Non-verbal communication comprises of eyes on the
patient, attentiveness, touch, active listening, empathy and smile that initiate conversations and
foster a non-judgmental atmosphere for both John and healthcare professionals (Pawlikowska et
al., 2012). Cultural sensitivity is also important while communicating with John as it makes him
comfortable to discuss his thoughts and feelings openly with the healthcare professionals. John’s
feedback on education session can be helpful for healthcare professionals to evaluate his level of
understanding and identifying knowledge gaps that require further teaching (Coulter, 2012).
Open-ended questions along with teach-back method can be helpful in confirming
understanding of the disease and assessment of behavioural changes through follow-ups,
medication compliance and symptom monitoring would be helpful in evaluating the
effectiveness of patient education (Tamura-Lis, 2013).
From the above case study of John, it can be concluded that follow-ups, self-care
management and patient education are essential elements after curative treatment of colorectal
cancer. Follow-ups help in early detection of disease relapse and in addressing the survivor
issues faced by cancer patients after curative treatment. Cancer survivors fear about recurrence of
the disease and stressed due to the side effects of medication and treatment. Effective

6COLORECTAL CANCER CASE STUDY
communication skills including verbal and non-verbal helps healthcare professionals to establish
rapport and trust with the patient helpful in improving patient satisfaction with better health
outcomes. In such cases, self-care management and behavioural change through transtheoritical
model of change can be beneficial in promoting self-efficacy and motivation in cancer survivors.

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