Patients’ experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy – a qualitative follow‐up study

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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offer the chance of a cure to patients with peritoneal carcinomatosis (PC) 1. Patients with PC suffer from gastrointestinal cancer with different origins in the abdominal cavity, and the treatment is challenging for the patients both physically and mentally. The selection process is rigorous 6, and the waiting time for surgery (4–8 months) and the recovery process are both long 7.
During the recovery process, patients go through changes and adapt to their new situation: they go through a transition 10. Transition occurs over time and is defined as a person's response to changes or important life events that occur in his or her life 10. According to the theory of transition, a person may go through transitions due to a change in his or her health status or a change in his or her role in the social environment 11. How well the person copes with this change is affected by critical events in his/her life, such as being diagnosed with a serious form of cancer, being aware of the change or the process that one goes through, getting involved in the process of self‐changing, being able to deal with the change and a time frame that may start with the critical change 12. Afaf Meleis emphasises that nurses are facilitators who understand and help the patients through the different stages of their transitions 10. Patients with PC have received a serious diagnosis and have gone through major abdominal surgery. Several of them had previous symptoms, which means that patients have gone through changes in their health and social status both before and after surgery 8.
The concept of recovery involves a physical, a psychological and an emotional component. Postoperative recovery is divided into three phases: an early phase which starts with discontinuation of anaesthesia until vital signs are stabilised, followed by an intermediate phase which is until the patient is ready for discharge, and a late phase which is the time frame between discharge and when the patient regains health and well‐being 13. The early (before discharge from the hospital) and intermediate (4 months after surgery) phases after CRS and HIPEC have been studied previously 8 and have shown that patients focus on getting well physically, regardless of the effects on their mental health. Not many patients sought professional counselling 8 or Acceptance and Commitment Therapy (ACT). The latter is a form of cognitive behavioural therapy that focuses on improving quality of life by actively working to overcome negative thoughts and emotions associated with the illness, since those negative feelings increase the suffering and reduce the possibility of future satisfaction and happiness 14. In our earlier studies 8, where patients with PC participated in interviews, we saw that they tried to solve their problems by themselves or with the help of their family members. In patients with PC, anxiety about the disease returning was present before discharge, as well as 4 months after surgery 8. However, the recovery process was different 4 months after surgery depending on whether patients received chemotherapy treatment after surgery or not, or whether the patient had a permanent or temporary stoma or had no stoma 9. During the interview, many described how they suffered from the side effects of the postoperative chemotherapeutic agents. Furthermore, not all of the patients with permanent stoma could cope with all aspects of having stoma, for example having intimate relations with their spouse or returning to work, due to problems with leakage, which sometimes affected their social life 9.
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