Colorectal Cancer: A Case Study on Discharge Planning & Management

This case study examines the discharge planning and collaborative care approaches for a colorectal cancer patient named John. It emphasizes the importance of effective discharge planning using the IDEAL framework, which includes patient and family involvement, discussion of key care areas, education on the condition, assessment of understanding, and listening to patient preferences. The study highlights the significance of collaborative approaches among healthcare professionals to ensure care continuity, prevent recurrence, and manage adverse effects of adjuvant therapy. It also covers strategies for monitoring recurrence, lifestyle modifications for improved survivorship, and the role of a multidisciplinary team in addressing the patient's physical, psychological, social, and spiritual needs. The case study underscores the patient's responsibility in adhering to medication, follow-up visits, and self-monitoring for signs of recurrence, ultimately aiming to improve the patient's quality of life and reduce the risk of cancer recurrence.

Running Head: COLORECTAL CANCER CASE STUDY
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Colorectal Cancer Case Study

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Colorectal cancer case study
Introduction
Colorectal cancer is among the most common diagnosed cancers. In the United States, it
ranks third in cancer diagnosis among men and women. However, due to factors such as reduced
risk factors, improved screening tests and treatment options, the mortality rates from colorectal
cancers have been continuously declining. For instance, Colorectal cancer incidence in men and
women aged fifty years and above decreased by 32% from 2000 to 2013 (Siegel et al, 2017).
Risk factors for colorectal cancer include a high BMI, increased sugar intake, increased alcohol
consumption, Consumption of red meat, cigarette smoking, reduced fruit and vegetable
consumption and inactivity (Johnson et al, 2013). Colorectal cancer is also more prevalent in
men and older adults. This paper discusses the case study of John, a colorectal cancer patient, an
effective discharge plan for him and collaborative approaches by health care professionals to
ensure care continuity and prevent and treat recurrence.
Discharge planning
Effective discharge planning is vital for the continuity of care especially in patients that
need long term care. The IDEAL discharge planning tool is designed to ensure patient inclusion
in their plan of care while ensuring continuity and follow up (AHRQ, n.a). The IDEAL discharge
plan is comprised of Inclusion of patient and family, Discussion of the key areas of care,
Education of the disease condition, Assessment of the patient and family’s understanding and
Listening to patient’s preferences, goals, and concerns.
Inclusion of the family in the plan of care is especially important as they are usually the
caregivers. For instance, In John’s case, his wife is his primary caregiver. She should, therefore,

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play a significant role in treatment plans for John and ensuring he adheres to medications and
scheduled follow up visits. As stated by (Laryionava et al, 2018) it is important to involve the
family early in treatment, and assessing their wishes and needs is vital in creating a specific-
tailored discharge plan for the cancer patient.
Discussion of key areas of care that would ensure a smooth transition from the hospital to
the home environment. These include reviewing the medication provided, the test results,
explaining the signs and symptoms of recurrence and the importance of adhering to follow up
appointments. In John’s case, he is required to take with him adjuvant therapy to aid in recovery
and reduce chances of recurrence by destroying any residual metastases. Side effects for these
medications may include Nausea and vomiting, Mucositis, fatigue, abdominal cramps, and
diarrhea, which John may experience (Macrae and Bendell, 2018 ). There may also be signs and
symptoms of nerve damage such as numbness and tingling, and myelosuppression and
leukopenia may be evident in laboratory results (Kim et al, 2018). It is important for John and his
wife to be able to recognize these symptoms of toxicity. If the side effects adversely affect his
ability to self-care or to continue with treatment, reporting to the physician for management is
advisable.
Patient education is among the most vital processes during discharge planning. It includes
an explanation of the disease condition, the importance of adherence to medication to prevent
recurrence and self-care strategies. A study by (Paterick et al, 2017) found that patient education
improves health literacy which in turn leads to better patient outcomes. In addition, patient
education also involves an assessment of the patient understanding of the provided instructions.
Communication behaviors such as engaging the patient in questions, avoiding medical

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terminology and using “teach back” enhance understanding and assessment of patient
understanding (Paterick et al, 2017).
Listening covers putting into consideration the patient and the guardian or family’s
concerns. In Johns case, his wife is his primary caregiver, and may be overwhelmed by the
responsibilities that come with caring for her husband. Emotional and psychological support for
the patient and his wife may be incorporated in the discharge plan to help them deal with the
condition. In addition, the financial situation at home, John’s preferred physical activities and
diet should also be put into consideration.
Collaborative approaches to education and planning for self-management.
After discharge, the main concern for colorectal cancer patients is preventing recurrence
and managing adverse effects of adjuvant therapy. However, the patient’s physical,
psychological, social and spiritual health should also be considered to enhance recovery. This
can only be done through collaborative approaches.
Recurrence of colorectal cancer is most likely to happen within the first two to three
years in 60% to 80% of all cases (Wilkinson, 2019). This is why screening and close surveillance
of signs and symptoms of recurrence are important. Recurrence can either occur locally,
regionally to lymph nodes close to the primary site of the tumor or can metastasize to distant
sites. Education regarding signs of recurrence is important.
Signs and symptoms that may appear following recurrence are usually similar to those of
primary tumor. They include changes in bowel habits like frequency, bloody stool, bloating and
excessive flatulence, reduced appetite and weight loss, fever and changes in the stool size. The
patient may also have a persistent cough, jaundice in the eyes or skin, and lethargy. Some people

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also experience a constant urge to defecate. The health care team should ensure John is able to
recognize these symptoms of recurrence and the appropriate measures to take. Laboratory tests
are also likely to show iron deficiency anemia. Hepatomegaly and ascites may also occur in
some cases (Bohorquez et al, 2016). It is important for John to recognize these symptoms early
enough to enhance treatment.
Surveillance of recurrence is done using a combination of different test and scans.
Physical examination should be done every three to six months after discharge for two years, and
then roughly every six months afterward for at least five years according to (Makhoul, Alva and
Wilkins, 2015). Physical examination is important in detecting the presence of a second
neoplasm and identifying side effects from adjuvant therapy. The Carcinoembryonic Antigen
(CEA) levels should also be checked every three to six months for two years and every half year
afterward. High levels of CEA indicate recurrence in almost 70 to 80 percent of patients. High
CEA levels should be accompanied by more laboratory work up to confirm recurrence before
treatment (Makhoul, Alva and Wilkins, 2015). Other surveillance studies include CT scans, chest
x-rays and hepatic imaging studies to detect metastases.
Colonoscopy and sigmoidoscopy are also recommended as they check and remove any
polyps and cancers that may have developed. All colorectal cancer patients should have a
colonoscopy exam annually after surgery. It is important for John’s health care team to stress the
importance of adherence to these follow-up visits. They allow for early detection and treatment
of recurrence.
Survivorship

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The aim of a survivorship plan is to improve the quality of life of the discharged patient
by ensuring all their physical, social and psychological needs are cared for. It incorporates
rehabilitation techniques to ensure self-management is done effectively. A multidisciplinary
team including nutritionist, physiotherapist, psychiatrist, Urologist among others must work
collaboratively for John to receive all optimal care.
Lifestyle modifications including diet changes and physical exercise are believed to
improve quality of life while at the same time reducing chances of recurrence. For instance, as
stated by (Pietrzyk, 2016) consumption of dietary fiber can lower the risk for colorectal cancer
by up to 50%. Other dietary recommendations that lower the risk of recurrence include foods
rich in vitamin B6, C, D and E, magnesium, folic acid, and reduced sodium intake. Considering
the available foods, the nutritionist should, therefore, make these dietary recommendations for
John, explain the portions and the reasons why it is important to make these changes.
Psychiatric evaluation should also be included in the survivorship plan to help John and
his wife cope with the psychological responsibility brought about by the effects of the disease.
Psychotherapy and spiritual therapy among other spiritual therapies can be effective (Kraljevic,
2013). Rehabilitation techniques including occupational therapy, psychotherapy, and physical
therapy should also be included. According to urinary and sexual dysfunction affects the patient
both physically and psychologically and can be treated through electric stimulation of the pelvic
floor muscles, biofeedback, and other physiotherapy techniques. Other symptoms like
neuropathy are remedied through Transcutaneous Electrical Nerve Stimulation (TENS),
Kinesiotherapy, acupuncture and sometimes massage therapy.

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Pain management is also a factor that greatly reduces the quality of life. Management can
be done through pharmacological measures which can be supported by rehabilitative techniques
such as physical exercise and massages.
Conclusion
Discharge planning is a vital part for the continuity of care, especially in cancer patients. It does
not just begin when the patient is about to be discharged but should be considered from
admission. In colorectal cancer patients, multi-disciplinary efforts are required to ensure optimal
care. All faculties should work collaboratively to guarantee the patient’s survival. However, the
patient also plays a major role in the continuity of care by ensuring adherence to medication and
follow up visits, and self-monitoring of signs and symptoms of recurrence. In addition, it is the
patient’s responsibility to reduce the risk of recurrence by maintaining a healthy lifestyle and
reporting any changes or adverse effects.

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References
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