Care after colorectal cancer surgery: the case for nurse-led outpatient clinics
Main Article Content
Abstract
Late complications following colorectal cancer surgery are prevalent, with over 50% of patients experiencing bowel and stool symptoms, up to 70% facing urinary dysfunction, and sexual dysfunction affecting 76% of men and 56% of women. Additionally, 24-39% of patients report depressive symptoms within the first year post-surgery. Traditional physician-led outpatient care models often fail to address the multifaceted needs of these patients, focusing primarily on recurrence detection. In contrast, nurse-led clinics, which are gaining popularity in various areas of cancer care, offer a holistic approach that encompasses both physiological and psychosocial support. We established a specialized nurse-led outpatient clinic for managing late complications after colorectal and anal cancer surgeries. Our model empowers specialized nurses to diagnose and treat a wide range of symptoms independently, involving physicians only when necessary. This nurse-led approach leverages the unique strengths of nursing practice, including empathy, patient education, and comprehensive symptom management, to support patients' transition to a "new normal" post-surgery. Nurses in our clinic follow treatment algorithms for common symptoms and consult with medical specialists for complex or unresponsive cases. The nurse-led clinic model enhances patient satisfaction, quality of life, and healthcare resource efficiency. However, challenges such as defining the scope of practice, ensuring adequate training, and integrating this model into existing healthcare systems must be addressed. Our experience suggests that this model can be broadly adopted across other healthcare areas. Future research should focus on evaluating long-term outcomes and strategies for broader implementation. In conclusion, integrating nurse-led consultations within a collaborative framework that includes doctors for specialized interventions represents a progressive approach to postoperative care for colorectal and anal cancer patients. This model promises to improve patient outcomes, satisfaction, and healthcare resource optimization by leveraging the holistic care approach of nurses alongside the specialized expertise of doctors.
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References
2. Haas S, Mikkelsen AH, Kronborg CJS, et al. Management of treatment-related sequelae following colorectal cancer. Colorectal Dis. 2023;25(3):458-488. https://doi.org/10.1111/codi.16299.
3: Simard J, Kamath S, Kircher S. Survivorship guidance for patients with colorectal cancer. Curr Treat Options Oncol. 2019;20(5):38. https://doi.org/10.1007/s11864‐019‐0635‐4
4: Gilmore B, Ezekian B, Sun Z, Peterson A, Mantyh C. Urinary dysfunction in the rectal cancer survivor. Curr Bladder Dysfunct Rep. 2016;11(2):105–12. https://doi.org/10.1007/s11884‐
016‐0357‐4
5. Duran E, Tanriseven M, Ersoz N, et al. Urinary and sexual dysfunction rates and risk factors following rectal cancer surgery. Int J Colorectal Dis. 2015;30(11):1547–55. https://doi.org/10.1007/s00384-015-2346-z.
6. Hansen SB, Oggesen BT, Fonnes S, Rosenberg J. Erectile dysfunction is common after rectal cancer surgery: a cohort study. Curr Oncol. 2023;30(10):9317-9326. https://doi.org/10.3390/curroncol30100673.
7: Den Oudsten BL, Traa MJ, Thong MS, et al. Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population‐based study. Eur J Cancer. 2012;48(17):3161–70. https://doi.org/10.1016/j.ejca.2012.04.004
8. Ismail FQ, Öberg S, Hageman I, Rosenberg J. High frequencies of depressive symptoms after treatment for colorectal cancer: a systematic review and meta-analysis. SN Compr Clin Med. 2023;5:83. https://doi.org/10.1007/s42399-023-01425-z.
9. Rosenberg J, Oggesen BT, Hamberg MLS, Danielsen AK. Establishment of a nurse-led clinic for late complications after colorectal and anal cancer surgery: a descriptive study. Support Care Cancer. 2022;30(7):6243-6250. https://doi.org/10.1007/s00520-022-07061-y.
10. Oggesen BT, Hamberg MLS, Thomsen T, Rosenberg J. Exploring patients’ perspectives on late complications after colorectal and anal cancer: a qualitative study. Curr Oncol. 2023;30(8):7532-7541. https://doi.org/10.3390/curroncol30080546.
11. Wiltink LM, White K, King MT, Rutherford C. Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term
symptoms and functional impairments. Support Care Cancer 2020;28:2523–2532. https://doi.org/10.1007/s00520-020-05301-7.
12. Luo X, Li J, Chen M, Gong J, Xu Y, Li Q. A literature review of post-treatment survivorship interventions for colorectal cancer survivors and/or their caregivers. Psychooncology
2021;30(6):807–817. https://doi.org/10.1002/pon.5657.
13. Been-Dahmen JMJ, van der Stege H, Oldenmenger WH, et al. What factors contribute to cancer survivors' self-management skills? A cross-sectional observational study. Eur J Oncol Nurs. 2024;69:102539. https://doi.org/10.1016/j.ejon.2024.102539.
14. Gyldenvang HH, Christiansen MG, Jarden M, Piil K. Experiences and perspectives of patients and clinicians in nurse-led clinics in an oncological setting: a sequential multi-methods study. Eur J Oncol Nurs. 2022;61:102203. https://doi.org/10.1016/j.ejon.2022.102203.
15. Donald F, Martin-Misener R, Bryant-Lukosius D, et al. The primary healthcare nurse practitioner role in Canada. Nurs Leadersh. 2010; 23 Spec No 2010:88-113. https://doi.org/10.12927/cjnl.2013.22271.
16. Fletcher CE, Copeland LA, Lowery JC, Reeves PJ. Nurse practitioners as primary care providers within the VA. Mil Med. 2011 Jul;176(7):791-7. https://doi.org/10.7205/milmed-d-10-00329.
17. McFarlane K, Dixon L, Wakeman CJ, Robertson GM, Eglinton TW, Frizelle FA. The process and outcomes of a nurse-led colorectal cancer follow-up clinic. Colorectal Dis. 2012; 14: e245-e249. https://doi.org/10.1111/j.1463-1318.2011.02923.x
18. Symonds EL, Simpson K, Coats M, Chaplin A, Saxty K, Sandford J, Young Am GP, Cock C, Fraser R, Bampton PA. A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines. Med J Aust. 2018;208(11):492-496. https://doi.org/10.5694/mja17.00823.
19. Corner J, Halliday D, Haviland J, Douglas HR, Bath P, Clark D, Normand C, Beech N, Hughes P, Marples R, Seymour J, Skilbeck J, Webb T. Exploring nursing outcomes for patients with advanced cancer following intervention by Macmillan specialist palliative care nurses. J Adv Nurs. 2003;41(6):561-74. https://doi.org/10.1046/j.1365-2648.2003.02568.x.
20. Lewis R, Neal RD, Williams NH, France B, Wilkinson C, Hendry M, Russell D, Russell I, Hughes DA, Stuart NS, Weller D. Nurse-led vs. conventional physician-led follow-up for patients with cancer: systematic review. J Adv Nurs. 2009;65(4):706-23. https://doi.org/10.1111/j.1365-2648.2008.04927.x.
21. Fitzgerald-Smith AM, Srivastava P, Hershman MJ. The role of the nurse in colorectal cancer follow up. Hosp Med. 2003;64(6):344-7. https://doi.org/10.12968/hosp.2003.64.6.344.
22. Oggesen BT, Danielsen AK, Hamberg MLS, Rosenberg J. Practical management algorithms for late complications after colorectal and anal cancer – basic treatment of late complications. Med Adv. 2023;1(3):260-269. https://doi.org/10.1002/med4.32.
23. Poghosyan L, Norful AA, Martsolf GR. Primary care nurse practitioner practice characteristics: barriers and opportunities for interprofessional teamwork. J Ambul Care Manage. 2017;40(1):77-86. https://doi.org/10.1097/JAC.0000000000000156.
24. Ma C, Shang J, Bott MJ. Linking unit collaboration and nursing leadership to nurse outcomes and quality of care. J Nurs Adm. 2015;45(9):435-42. https://doi.org/10.1097/NNA.0000000000000229.
25. Currie V, Harvey G, West E, McKenna H, Keeney S. Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review. J Adv Nurs. 2005;51(1):73-82. https://doi.org/10.1111/j.1365-2648.2005.03462.x.
26. Lei YY, Ya SRT, Zheng YR, Cui XS. Effectiveness of nurse-led multidisciplinary interventions in primary health care: a systematic review and meta-analysis. Int J Nurs Pract. 2023;29(6):e13133. https://doi.org/10.1111/ijn.13133.
27. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 2002;324(7341):819-23. https://doi.org/10.1136/bmj.324.7341.819.
28. Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ. Nurses as substitutes for doctors in primary care. Cochrane Database Syst Rev. 2018;7(7):CD001271. https://doi.org/10.1002/14651858.CD001271.pub3