CN53 Rectal cancer survivorship: The struggle of the low anterior resection syndrome (LARS) E. Pape1 , P. Pattyn1 , A. van Hecke2 , N. Somers3 , D. Van De Putte1 , W. Ceelen1 , E. van Daele1 , W. Willaert1 , Y. van Nieuwenhove1 1
Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium,2
University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium,3
Faculty of Medicine, Ghent University, Ghent, Belgium
Background: Due to better surgical techniques and radiotherapy there is an increase in sphincter saving procedures for rectal cancer. The benefit of this approach is the lack of a permanent stoma but it conducts a big change in the bowel habits namely LARS. When a permanent stoma could be avoided these patients are prepared to make exten-sive adjustments in order to accept the new lifestyle without a stoma. Patients experi-ence a number of functional, psychological and social problems. These symptoms worsen immediately after the surgery and improve in the following months. However some patients experience permanent difficulties. Literature identifies that 60 to 90% of all patients suffer from LARS with a negative impact on the quality of life (QOL). Methods: A cohort of surviving patients, who underwent a low anterior resection for rectal cancer, were identified. These patients were treated in the University Hospital in Ghent between January 1, 2006 until September 15, 2016. QOL was assessed using the EORTC QLQ C30 questionnaire and the bowel function using the validated LARS score. The relationship between LARS and QOL and the risk factors for developing LARS were analyzed. Patients with a major LARS score ( 30 points) were contacted to explore their management of LARS.
Results: A total of 121 patients were included in this study. 69% of these had major LARS. QOL was closely associated with LARS. Significant differences were found in the global health status, functional (physical, role, cognitive and social) and symptom (fatigue, pain, insomnia and diarrhea) scales. The height of the anastomosis was a risk factor for major LARS. Most patients used dietary regimens, medication and inconti-nence material in an attempt to manage their LARS.
Conclusions: The removal of a temporary stoma signifies for many patients and their social network the completion of treatment. However, after several years, 69% of these patients are still suffering from bowel difficulties. Patients with major LARS have a sig-nificant decreased QOL. For this reason it is imperative that the caregiver is aware of this problem. At this time there is no golden standard for the management of LARS. Patients and their informal caregivers are managing this condition through trial and error.
Legal entity responsible for the study: Gastrointestinal surgery University Hospital Ghent.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.
CN54 Nurse-led approaches to self-management of symptoms in routine Swiss outpatient care: A qualitative exploration
K. Ribi1 , M. Bana2 , S. Peters3 , S. Kropf-Straub4 , E. N€af5 , S. Zu¨rcher4 , M. Eicher6 1
Institut Universitaire de Formation et de Recherche en Soins – IUFRS, University of Lausanne, Lausanne, Switzerland,2
School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland, 3
Multidisciplinary Oncology Center, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland,4
Departement of Practice Development in Nursing, Hospital Group Lindenhof, Bern, Switzerland,5
Departement of Practice Development in Nursing, Solothurner Spit€aler AG, Kantonsspital Olten, Olten, Switzerland,6
Departement of Oncology - Institut Universitaire de Formation et de Recherche en Soins – IUFRS, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland
Background: The Symptom NaviVCProgram is a new nurse-led intervention to facili-tate patients’ self-management of symptoms. Testing this intervention in a comparative study requires the assessment of nurses’ routines to support patients’ self-management competencies in order to interpret the magnitude of the effect of the intervention. As part of a larger study, we aimed at gaining insight into these routines provided in the Swiss outpatient setting, specifically into those related to symptoms caused by anti-can-cer therapies.
Methods: We conducted focus groups (FG) with nurses at four cancer outpatient cen-ters. FG were held before introducing the program, and were audio-recorded and tran-scribed verbatim. Two researchers independently conducted a thematic analysis using a deductive approach to identify themes related to self-management support. Emerging themes were discussed until consensus.
Results: Four FG (one per center) with a total of 15 nurses revealed three main themes. The 1sttheme covered information provision including both general information, and information tailored to the patient’s situation. The 2ndtheme involved patient-centered care that was realized by a primary nursing approach and by focusing on each patient’s unique psycho-social needs. The 3rdtheme addressed the documentation of the care process, which was considered important to monitor the course of care and to share information between health care professionals. The level of standardization of consul-tations varied between centers ranging from experienced-based to highly structured, with peer-led quality assurance.
Conclusions: Nurse routines to support patient’s self-management of symptoms show similar key themes across four centers in Switzerland. We identified information provi-sion to be the main focus of nurses’ support. Levels of standardization of the consulta-tions varied across centers. Our results also showed that other self-management competencies considered relevant for patients (problem solving skills, decision making, or tailored action planning) are not yet explicitly addressed in nurse-led consultations. Legal entity responsible for the study: University of Lausanne and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne.
Funding: Institut Universitaire ee Formation et de Recherche en Soins (IUFRS), University of Lausanne, School of Health Sciences Fribourg, Hospital Group Lindenhof Bern; Altschu¨ler Foundation St. Gallen, Swiss Cancer League. Disclosure: All authors have declared no conflicts of interest.
CN55 Evaluation of a nursing aftercare intervention for patients with head
and neck cancer treated with chemoradiation
C. Braat1
, G. Verduijn1
, H. van der Stege2
, M. Offerman3 , M. Peeters2 , A. van Staa2 , W. Oldenmenger4 1
Radiotherapy, Erasmus MC Cancer Insitute, Rotterdam, Netherlands,2
Kenniscentrum Zorginnovatie, Hogeschool Rotterdam, Rotterdam, Netherlands,3
Head and Neck Oncology, Erasmus MC, Rotterdam, Netherlands,4
Oncology, Erasmus MC Cancer Insitute, Rotterdam, Netherlands
Background:Head and neck cancer (HNC) patients treated with chemoradiation have to rediscover their life after recovering from severe side-effects and build-up self-confi-dence. To assist patients in this, an aftercare intervention to support patients’ self-man-agement was implemented. This study aimed to evaluate the feasibility and first effects.
Methods:HNC patients treated in the Erasmus MC between November 2015 and
November 2016 were included in the intervention group (n¼ 39). They received a nurse-led intervention using the Self-Management Web (SMW) while patients of the historical control group received standard care. The SMW contains 14 areas of life on physical, psychological and social themes and was used to set priorities, define goals and make action plans for the future. Patients completed questionnaires on quality of life, self-management behaviour, self-efficacy and quality of care. Additionally, individ-ual interviews were performed to gain insight into patients’ experiences with the after-care intervention.
Results:Patients in the intervention group showed a significant reduction in anxiety and an increase in self-efficacy. The differences between the extent to which the nurse paid attention to the topics compared to the importance patients attached to these were small. They need more attention to knowledge about their disease, emotional and spiri-tual well-being and self-care; patients in the control group indicated that they wanted more attention on all topics. No significant differences were found in quality of life and self-management behaviour between both groups. In the interviews, patients highly appreciated the opportunity to discuss a broad range of topics and recommended it for standard practice.
Conclusions:HNC patients experience a significant reduction in anxiety and increased levels of self-efficacy after our aftercare self-management intervention. The topics of the SMW represent a complete overview while the solution-focused approach encour-ages patients to set goals for their recovery progress.
Legal entity responsible for the study:Erasmus MC.
Funding:Has not received any funding.
Disclosure:All authors have declared no conflicts of interest.
VCEuropean Society for Medical Oncology 2018. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
Annals of Oncology 29 (Supplement 8): viii698–viii701, 2018 doi:10.1093/annonc/mdy278
