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Stoma-related considerations in palliative patients

02 October 2021
Volume 26 · Issue 10


In the community there are about 200 000 people with a stoma. Some of these may have been performed as a palliative procedure to relieve a bowel obstruction, for example. Alternatively, the condition of the patient may have altered. A person with a stoma may, for many reasons, be approaching the end of life. There are a number of stoma-related issues that can occur at the end of life as a result of cancer treatment, such as skin around the stoma being damaged as a result of chemotherapy or changes in weight. In the palliative setting, patients may no longer be able to independently care for their stoma and may require assistance from the community nurse. Input from the community nurse may include information on changing stool consistency, as a result of disease progression or cancer treatment. Alternatively, nursing input might be necessary to train carers to perform stoma care. Community nurses can also provide knowledge to patients to improve understanding and decrease anxiety at the end of life.

In the UK, about 1 in every 20 people will develop colorectal cancer (Office for National Statistics (ONS), 2019). Although the bowel cancer screening programme has reduced colorectal cancer from the third to the fourth most common cancer diagnosis in the UK, it is most commonly diagnosed in a late stage (ONS, 2019). This means that the cancer is less curable and, thus, people are more likely to need palliative care in the first few years after the cancer diagnosis. The reason for late presentation is uncertain, but, with the pandemic, it is known that many people are now presenting with late symptoms of cancer, such as bowel obstruction or bowel perforation. Therefore, it likely there will be an increase in patients who have a stoma and who require palliative care as a result of the pandemic.

The number of people in the UK with a stoma is likely to rise as a result of the pandemic. This is for two reasons: first, surgery to reverse temporary stomas is being delayed, and second, the type of surgery commonly being undertaken has changed. More so than ever before, for people who have emergency surgery, it might be safer to form a stoma rather than risk an anastomotic leak in an already severely compromised patient. The risk factors of colorectal cancer include increased age, smoking, high alcohol consumption, obesity and physical inactivity (Pande and Frazier, 2014). It is recognised that the UK population, in general, is getting older, and obesity is on the increase; thus, it is likely that colorectal cancer numbers will continue to rise.

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