CA: A Cancer Journal for Clinicians, Vol 35, 170-183, Copyright
© 1985 by American Cancer Society
Psychosocial Sequelae of Ostomies in Cancer Patients
Christoph Hurny M.D.1 and
Jimmie Holland M.D.2
1 Assistant Attending Physician in the Medical Division Lory of University Hospital in Bern, Switzerland.
2 Chief of the Psychiatry Service of Memorial Sloan-Kettering Cancer Center in New York, New York.
Extensive surgery is often necessary in the attempt to cure cancer and to save the patient's life. Dukes and Sutherland and associates in the early 1950s were among the first to recognize that improving survival was only one side of the problem. They first asked the question: What is the quality of life of patients with rectal cancer once they have been cured by abdominoperineal resection and colostomy? These researchers found that the fact of having a stoma could considerably jeopardize the patient's quality of life.
In the last 30 years, much has been done to improve the quality of life for patients with ostomies: better surgical techniques with fewer sequelae, improved technical devices for practical management of the stoma, better understanding of the accompanying psychosocial and sexual problems, and support through ostomy groups and enterostomal therapists. In spite of these improvements, however, even today it is a very difficult experience to face the diagnosis of cancer and to have a stoma. We have outlined the main problems patients and their families have to deal with in adjusting to life with an ostomy. These problems involve every aspect of life: physical, emotional, and interpersonal (especially sexual) (Table 3). Although most patients cope well, they need considerable support and continuous care.
It is also difficult for the busy physician to cope with the patient's questions and concerns about the stoma. Except for the early 1950s, most studies about the patient's point of view continue to be published in psychiatric and nursing journals. Although nurses and enterostomal therapists may be more familiar with the practical and emotional problems of stoma patients, the surgeon is still the expert to most patients. Surgeons should have answers to every question about the operation and its results. It is a common myth within the medical community that telling patients about possible side effects makes them more apt to occur; patients are better off not being told, the reasoning goes. This myth has long ago been dispelled. Correct information given empathetically is one of the best ways to lead the cancer patient through the experience of living with an ostomy. Another important principle is to listen and to detect psychosocial problems early, so that they can be confronted and treated before they become fixed.
Based on our personal experience with patients and on that discussed in the literature, we have worked out guidelines for the physician's management of the cancer patient with an ostomy (Table 5).
In everyday medical practice, some of these points are observed and some are not, depending on the sensitivity of the care-takers. We hope that this article helps to further improve the quality of life of cancer patients with an ostomy, so that despite their limitations they not only survive, but live a full life.
