Common concerns after bowel cancer treatment

My role as a Clinical Nurse Specialist

As a Clinical Nurse Specialist I am trained to offer expert advice and support for patients who are diagnosed with cancer, my area of clinical expertise is in lower GI cancer, including bowel cancer.

I am the main point of contact for patients and can answer any questions they may have about their diagnosis and treatment, as well as co-ordinate their care through the wider multidisciplinary team. The thing I enjoy most about my role is the close relationship I build with patients, and it is a privilege that I am able to guide and support them during an incredibly difficult time.

Common concerns after bowel cancer treatment can be both emotional and physical

Cancer treatment can be tough, so it can take some time for your body and mind to recover.

The first 3 to 6 months after completing treatment is usually the most difficult. Weekly or even daily hospital visits are now periodic follow ups, that are often a few months apart. This coupled with the reality of processing the psychological effects of cancer and adapting to the side effects of treatment, can be a lot to manage.

As well as the emotional impact of treatment patients can often experience physical symptoms, this includes longer term side effects of treatment, with bowel cancer one of the most common concerns is the changes to bowel habits.

Bowel habits may change after treatment

However these can be effectively managed through medication or by adopting simple changes to toilet routine. As surgery is the main treatment for early and locally advanced bowel cancer you may experience temporary or longer lasting functional bowel issues. The severity of this varies, it can be a big adjustment for some whereas others need to make simple changes, like avoiding certain foods.

 

Broadly speaking, a third of patients will suffer with constipation, a third will suffer with looser stools and increased frequency and the remaining third will go back to their normal routine. This depends on multiple factors including the extent of the surgery and where the tumour was located within the bowel.

There are various different medications available that can help to manage both constipation and increased frequency of looser stools. The main thing is to ensure you discuss any changes with your medical team so that they can put an effective plan in place to help you manage this.

If you are experiencing constipation, there are some simple changes to toilet routine that can make a real difference. Try sitting with your knees up on a foot stool or sitting in the normal way but simply leaning forward slightly – this can really help. And it sounds simple but many people don’t give themselves enough time to visit the toilet, setting aside ten minutes to relax and take your time can make the world of difference.

Diet plays an important role in managing bowel habits after treatment

You may find that you need to adjust your diet after treatment. To help identify the effect of certain foods it’s a good idea to keep a food diary. If you are introducing a new item of food, such as a small portion of green veg or salad, you can keep note and see what happens over the next 24 hours, then add something else in, and so on. That way it’s easy to assess the impact of different foods and create a diet that works for you.

After surgery it can take time for your bowel to readjust, so certain foods may cause diarrhea or tummy pains. But often, if you try the same food again in a few months’ time, it may not cause the same issues.

We have a great team of specialist dieticians who provide advice and support before you leave hospital, they are available to provide ongoing advice as you recover from treatment and help you to establish a healthy diet that works best for you.

Adjusting to active treatment

The psychological effect of finishing treatment can be equally, if not more, challenging as the physical effects

After treatment it can be hard to adjust to a ‘new norm’, active treatment means you are intently focused on your treatment plan and have frequent interactions with your medical team. Once that focus is gone processing the emotional impact of your diagnosis and treatment can be challenging, as well as the change to what has become your healthcare routine.

There is so much support available to people living with and beyond cancer and I encourage all patients to seek out as much support as they need. Everyone is different and for some they may need more support, or others may need that support for an extended period of time. Some people find support groups really cathartic, while others find one to one emotional support more comfortable, there is no one size fits all, it’s all about finding what feels right for you.

Understandably surveillance scans at regular intervals after treatment can often be an anxious time, you may have heard this referred to as ‘scanxiety’, and the fear of recurrence can be significantly heightened during this time. I tend to get a lot of calls from worried patients around the time of their scans, concerned about changes to their health. This is totally understandable, as a CNS I get to know my patients really well so most of the time I am able to provide reassurance and advice. There may be times when we feel it is necessary to bring scan dates forward or recommend further investigations depending on the symptoms patients are experiencing. It is really important to report any symptoms you have. There is no such thing as an unnecessary call or email.

For some people body image may be a concern, particularly after surgery that may result in significant scars or stomas. Again, managing this will be about finding what is right for you. Some people do not have any concerns, while others may prefer to find clothing that can cover scars, and for people with stomas we are seeing some amazing bespoke clothing becoming available as well as increasingly discreet stoma bags.

However you feel after your bowel cancer treatment just be reassured that you are not alone, as a CNS I am here to support my patients in any way I can for as long as they need. This may be offering expert reassurance, guidance or advice, or by signposting to other resources and healthcare professionals that can provide additional support. The most important thing to remember is that if you are struggling with emotional or physical challenges after cancer treatment, speak to a member of your clinical team and we’ll help get you the support you need.