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Course: Oncology Nursing�Topic: Surgery in Cancer Treatment Part 2

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the impact of cancer surgery on various aspects of the patient's overall health.
Discuss the prevention, detection, and management of common health alterations experienced by people undergoing surgery for cancer.
Explore nurse’s role in during pre and post surgery for cancer.

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Pre-op Assessment and Management of Cancer Surgery

Pre-operative evaluation involves:

Individual assessment
Site-Specific assessment
Pre-operative education

EdCaN module: Fundamentals of cancer surgery. Care of the person affected by cancer having surgery.

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Pre-op Assessment and Management of Cancer Surgery

Nutritional status must be assessed

Malnourishment could be treated with parenteral or enteral nutrition before surgery

Cardiopulmonary considerations include

Perform assessment of cardiac or pulmonary disorders that pose peri/post-operative risks
Cessation of smoking before surgery improve peri-operative outcome

General medical issues include screening with pre-operative-

Serum blood urea nitrogen (BUN)
Serum creatinine, sodium, calcium and full blood count

EdCaN module: Fundamentals of cancer

surgery, Individual Assessment.

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Pre-op Assessment and Management of Cancer Surgery

EdCaN module: Fundamentals of cancer surgery, Individual Assessment.

Where possible the surgery must be postponed in myelosuppressed patient as a result of chemotherapy or hematologic malignancy
Psychological impact of surgery may be intense in patient

Psychological preparation linked to shortened hospital stay and decreased need of analgesia
Provide patients with opportunity to verbalize fears/concerns
Multidisciplinary team shares the responsibility of pre-operative teaching

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Pre-op Assessment and Management of Cancer Surgery

Site specific assessment considerations-

Surgery for cancer within pelvis

Patient at risk of emotional distress from infertility post-surgery
Timely referral to fertility specialist for fertility preservation
Sperm, oocyte, embryo cryopreservation standard practice

Colorectal surgery requiring stoma

Stomal therapist should provide patient with reassurance/information on functions and care of stoma
Stomal therapist can assist surgeon identify best location for stoma, for easy self-management by the patient

EdCaN module: Fundamentals of cancer surgery, Individual Assessment.

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Pre-operative Education

Positively influences patients’ post-operative outcomes
Empowers patient’s self-management that facilitates recovery
Comprehensive information vital for informed consent
Key principles of pre-operative education include:

Consideration of the individuals coping style
Tailored information which suits their general level of comprehension, education and cultural background
Communication of the risks involved in their surgery
Consideration of the timing of education to avoid times of elevated anxiety, such as immediately preceding surgery

EdCaN module: Fundamentals of cancer surgery. Pre-operative Education.

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What would be the nurse’s role in care of the cancer patient during the pre-operative period?

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Nurse’s Role in Pre-operative Assessment/Management

Ensure patient is well informed of the surgery choices with information on

Risks and benefits of surgery
Side effects and complications
Probability of full recovery/recurrence

Ensure patient is informed about the procedure or surgery of choice

what happens before surgery and how to prepare for surgery
what will happen during surgery
what to expect after surgery and what sort of follow-up will be needed

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Nurse’s Role in Pre-operative Assessment/Management

Communicate the concerns of the patient with appropriate team member and address them properly
Ensure patients’ informed consent is taken prior the procedure
Alleviate or minimize anxiousness in patients through timely and sensitive information on result findings
Provide supportive care

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Nurse's Role in Pre-operative Assessment/Management

EdCaN module: Fundamentals of cancer surgery. Pre-operative Education.

Support patient- smoke-free period before surgery by:

creating/encouraging a smoking cessation program that begins before surgery, focuses on education regarding the effects of smoking on surgical outcomes
providing knowledge that enables them to make an informed decision about smoking abstinence
undertaking further research to determine if the surgical outcome education provided reduces people's pre-operative and post-operative smoking habits.

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Intraoperative Issues and Management

Hypercoagulable state common in people with cancer

Particularly in patient with advanced disease and primary brain tumors
Risk higher with obesity, advanced age, orthopedic or neurological surgery, impaired mobility
Perioperative deep vein thrombosis (DVT) must be considered
Administer appropriate level of prophylactic treatment
Low molecular weight heparin (LMWH), graduated compression stockings and sequential compression devices should be considered in all cancer surgery patient

EdCaN module: Fundamentals of cancer surgery. Intra-operative period.

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Intraoperative Issues and Management

Bleeding

Is part of any surgery and is usually controlled
Serious bleeding may require another operation to find the source and stop it
May require blood transfusion to replace lost blood

Damage to nearby tissues and organs

Internal organs and blood vessels can be damaged during surgery
Doctors are careful to do as little damage as possible

Drug reactions

Some people may have reactions to drugs used during surgery
Vital signs and other signs are carefully monitored to correct it

American Cancer Society (2019)

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Post-operative Issues and Management

Friese & Aiken, 2008, as cited in EdCaN Module/Post-operative period, 2018.

Post-operative support is very important for the wellbeing of overall health.
Patients with successful navigation of post-operative complications are more likely to

commence adjuvant therapies with less toxicity.
complete therapy in a timely manner ensuring effective dose intensity.

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Post-operative Issues and Management

Frequently observed post-surgery complications include:¹

Atelectasis, Hypokalaemia, Hypovolemia, Dehydration, Hypotension.

Other potential nursing care issues/considerations post-operation:²

acute respiratory distress syndrome, aspiration pneumonia,

infection, bleeding, poor wound healing, stomatitis.

Pain is normal after surgery, but it should not slow down recovery

Accurate assessment and targeted management intervention with appropriate analgesic necessary^2,3.

Friese & Aiken, 2008, as cited in EdCaN module/Post-operative period, 2018.
Yarbro et al, 2005, as cited in EdCaN module/Post-operative period, 2018.
American Cancer Society (2019).

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Post-operative Issues and Management

American Cancer Society (2019).

Infections

Patient should be assessed and monitored carefully for infections.
If present, is treated with appropriate oral or IV antibiotics.
Deep breathing exercises as soon as possible post-surgery helps decrease lung infections.

Slow recovery of body functions

Getting out of bed and walking around as soon as possible post surgery can help lower risk of slow recovery of bowel activity.

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Post-operative Issues and Management

Bowel and bladder dysfunction

Common complications following resections for prostate, colorectal, and gynoecological cancers.
Result of damage to autonomic pelvic nerves causing need to strain to initiate voiding, constipation, urinary/fecal incontinence.
Management of bowel issues:

Ask the patient to avoid foods that upset their bowel.
Refer to dietician if needed.
Loperamide might be prescribed for loose motions and Stool softeners/laxatives for constipation.

Cancer Research UK, 2018, Bowel changes after treatment.

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Post-operative Issues and Management

Patient education on rectal skin care, toileting habits
Encourage regular exercises to keep bowel working normally

Management of bladder problems:

Educate patient to drink plenty of fluids and avoiding caffeine, carbonated drinks, spicy foods, alcohol
Medicines may be prescribed to control any bladder spasms
Neurogenic bladder may be treated with medicine or surgery or managed by placing urinary catheter

Canadian Cancer Society, n.d., Bladder problems.

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Post-operative Issues and Management

Body-image and self-esteem difficulties related to altered body structure and function

Patient might show poor adjustment related to altered body image, and function
It can lead to poor quality of life post-surgery
Health care provider must screen for body image/self-esteem difficulties in patient and provide supportive care accordingly

Fingeret et al. (2014)

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What would be the nurse’s role in post-operative care of cancer surgery patient ?

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Nurse’s Role in Post-operative Care

Careful assessment of vital signs/other signs in patient for:

Internal bleeding/shock
Infection
DVT

Rapid management of emergencies such as shock
Careful assessment and management of pain with appropriate analgesic based on evidence based practices
Encourage and assist patient to

Perform deep breathing exercises
Ambulate as soon as possible, if not contraindicated

Assess and screen patient for body-image/self-esteem difficulties and carry out appropriate intervention to address the issue

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Nurse’s Role in Post-operative Care

Provide patient education on:

Wound care of surgical site
Proper nutrition
Bowel dysfunction management strategies

Sitting for bowel movement only after a very strong urge
cleaning anal area with mild soap and tepid water, pat drying with clean towel
regular exercise

Bladder dysfunction management strategies

Drinking plenty of fluids, avoiding caffeine/spicy foods
Proper care of catheter if in situ

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Red Flags

Fever
Rapid pulse, rapid breathing, cold clammy skin, low BP = Signs of Shock
Swelling, redness, pus at incision site
Pain affecting patient’s mobility
Deep vein thrombosis- pain, swelling in the legs

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Reference:

American Cancer Society, October 2019, Risks of Cancer Surgery. Accessed from: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/risks-of-cancer-surgery.html

Cancer Australia. (2018) EdCaN module: Fundamentals of cancer surgery/Care of the person affected by cancer having surgery. version 2.1. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/surgery/care-of-person

Cancer Australia. (2018) EdCaN module: Fundamentals of cancer surgery/Individual Assessment. version 2.1. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/surgery/care-of-person/pre-op-assessment

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Reference:

Cancer Australia. (2018) EdCaN module: Fundamentals of cancer surgery/Intra-operative period. version 2.1. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/surgery/care-of-person/intraoperative-issues

Cancer Australia. (2018) EdCaN module: Fundamentals of cancer surgery/Post-operative period. version 2.1. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/surgery/care-of-person/post-op-care

Cancer Australia. (2018) EdCaN module: Fundamentals of cancer surgery/Pre-operative education. version 2.1. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/surgery/care-of-person/pre-op-education

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Reference:

Canadian Cancer Society (n.d.). Bladder problems. Accessed from: https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/bladder-problems/?region=on

Cancer Reasearch UK (November, 2018). Bowel changes after treatment. Accessed from: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/living-with/bowel-changes-after-treatment

Fingeret, M. C., Teo, I., & Epner, D. E. (2014). Managing body image difficulties of adult cancer patients: lessons from available research. Cancer, 120(5), 633–641. https://doi.org/10.1002/cncr.28469

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