Bowel cancer in the Netherlands

One day everything changed for Mrs. Jansen. She had been having problems with her intestines for a while, was tired and she found blood in her stool. She went to the doctor to find out what was going on. The doctor gave her bad news: she had colon cancer. Bowel cancer ranks second in the Netherlands as the most common cancer in the Netherlands. The number of people who develop colon cancer is approximately the same for men and women. In 2005, a total of 10,000 Dutch people were diagnosed with colon cancer: 5,300 men and 4,700 women. In the same year, 2,300 men and 2,200 women died as a result of this disease. Compared to 2003, there has been a slight increase in the number of patients. In that year, 9,898 Dutch people became colon cancer patients, which is 102 fewer than in 2005. Bowel cancer can be divided into two variants, namely small intestinal cancer and colon cancer. The risk of small intestine cancer increases as one gets older (around 60 years) and is more common in men than in women. In addition, it is common in Western society. Colon cancer, like small intestine cancer, often occurs in people aged 60 or older, but with exceptions it can also occur at a younger age. This form of cancer usually arises from a polyp (bulge, thickening) on the inside of the intestinal wall. Although polyps are generally benign, there is a chance that they can develop into malignant tumors. The symptoms often depend on the location of the tumor, but usually the patient experiences worsening pain when moving and problems with bowel movements. The risk of colon cancer in a healthy person can only be increased by eating more than 160 grams of red meat and meat products every day. Additional research needs to be conducted to see whether this applies to all people. The chance of survival after 5 years is around 50-60%.
Heredity can be indicated as an internal cause of colon cancer, although this is only in 5 to a maximum of 10% of cases. Cancer is caused by a mutation in the DNA and this DNA is passed on to the offspring by the parents. In addition to internal factors, there are also external factors that can increase the risk of (colon) cancer. An important factor for an increased risk of various types of cancer is smoking, both cigarettes and cigars and pipes. Another important factor is an unhealthy drinking and eating pattern. This includes excessive use of alcohol, too much fat and salt in the diet and too little fiber and vitamins. The environment also makes its contribution. Many people have to work with toxic and carcinogenic substances, such as asbestos, as part of their job.
There are various methods for the treatment of colon cancer. Various factors play a role in determining the correct treatment, such as the size of the tumor and any metastases. The final decision whether or not the patient undergoes the particular treatment still comes from the patient himself. After all, he or she is the one who experiences the consequences of the treatment. Our problem statement is therefore: What are the personal consequences for the patient who has undergone treatment for colon cancer?

Therapy

Before colon cancer can be treated, the stages of the cancer must first be determined. There are two classifications used to describe the stages of colon cancer. The Dukes classification (from A to D) can be used. This classification overlaps with the TNM (Tumour, Nodes, Metastases) classification, so we will only show the Dukes classification.

  • Dukes A: Tumor that is only in the intestine
  • Dukes B: Tumor has grown through the intestinal wall, without metastases
  • Dukes C: Metastases only in nearby lymph nodes.
  • Dukes D: The metastases have spread throughout the body.

By determining what stage the tumor is in, the best possible treatment can be applied. There are various treatments for colon cancer. The most common are chemotherapy, radiation (radiotherapy) and surgery. Chemotherapy and radiotherapy both aim to shrink the tumor and reduce its effectiveness.
The aim of these three treatments is to try to stop or at least slow down the disease as much as possible. They also aim to alleviate the complaints or even prevent them. However, one treatment is often not enough and a combination is used. That is why research has been done into combining different treatment methods. This can be done by combining surgery with chemotherapy or radiotherapy, which is called systemic treatment. The results of this research were positive. Applying radiotherapy before or after surgery reduces the size of the tumor, while chemotherapy aims to eliminate or delay the spread of metastases. System therapy is now used in many colon cancer patients as part of the treatment and the chances of survival have increased to 10 – 15%.
According to Hidde J. Haisma (2002), gene therapy can also be used in the fight against cancer. For example, a corrected version can be added to defective genes or the gene can be repaired (Haisma, 2002, p. 9). So, as it were, a new gene is introduced into the cells in the body to cure the cancer cells. For example, the immune system is activated, causing these ‘new’ cells to recognize and destroy the cancer cells.
There are therefore various options for the treatment of colon cancer.

The consequences

Every treatment has consequences. After treatment for colon cancer, the person must live with the consequences for the rest of his life. The treatment of colon cancer causes the patient to experience many side effects. Even after treatment has taken place and the tumor has been removed, many physical or psychological side effects still occur. The most important physical side effect is fatigue, but less muscle strength, weight loss, difficulty sleeping, nausea, weight fluctuations and pain can also occur. Fatigue mainly occurs after treatment or during radiotherapy or chemotherapy. According to De Backer’s research (De Backer et al, n.d.), 70% of patients indicate that they suffer from this. The fatigue complaints often persist for a long time after treatment and negatively affect the patient’s life.
As a result of the disease colon cancer, people can get a stoma. With a stoma, an opening is made in the abdomen to drain urine or feces if the patient is unable to do so. Not everyone gets a stoma, this depends on the size and location of the tumor and how the operation went. After the patient has received a stoma, he/she receives information about how the stoma is used and instructions on how to use aids. This is done by a stoma nurse.
In 1996, a study was conducted by a rehabilitation center. The aim of this study was to investigate whether cancer patients with the prospect of a long recovery needed a rehabilitation program. A quarter of the people studied were patients with colon cancer. Of the research group, 26% needed professional help in psychological, social and physical areas. This involved reducing fatigue complaints, setting new goals, dealing with the social environment and nutrition.
People who have had cancer often experience a sense of loss afterwards. This concerns, for example, the loss of confidence in one’s own body, future prospects, social relationships and bodily functions. The Dutch Center for Mental Public Health conducted a study into this in 1992. The study showed that after the diagnosis and treatment of cancer, most psychological complaints (87%) were: insecurity, fear, powerlessness and sadness. However, it often happens that patients have complaints in different areas. This can be seen in physical complaints (fatigue and pain), because this affected another 60% of the people. Then come the relational problems (47%), mainly the lack of understanding and the loss of contacts. Another 40% of the complaints concerned problems surrounding the medical care provided. The financial and/or practical problems (problems with insurance and loss of work) only occurred in 20% of the cases.
The psychological complaints exceed all other complaints. People become insecure and fear the disease returning. The environment often responds with joy that the person has been healed, but the person himself or herself is not yet ready for this joy. He/she is mainly experiencing a lot of sadness and uncertainty. Below is a quote from a woman who had colon cancer and experienced the psychological consequences afterwards. The first time I went in feeling confident and quite carefree, the weather was nice and I was confident that my body could handle it. But eventually I went to the outpatient clinic with a heavy heart, because then I knew what to expect. My body became weaker, I became tired. (Hagens, 2004, p.69)
However, it differs from person to person how he/she experiences the consequences of treatment.

Conclusion

The problem statement was presented in the introduction, which was: What are the personal consequences for the patient who has undergone treatment for colon cancer? The personal consequences after colon cancer are often greater than expected. The biggest setback often comes after the treatment. People are most often confronted with psychological complaints: no future prospects, uncertainty, loss and fear that the cancer will come back. The most common complaint is fatigue and pain after treatment. In some cases, people get a stoma, which completely changes their lifestyle and can require the use of assistive devices for the rest of their lives. Getting back to life after cancer often requires guidance from your GP or care providers. People have to give it a place in their lives. It is important that they accept the consequences and try to live with them.

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