Surgery not always best cancer treatment option

Weigh advantages and disadvantages before decision

Unlike chemotherapy, radiation, or biological therapy, most patients are familiar with surgery for it is a common form of treatment. Yet there are many issues about surgery to remove a malignant tumor that patients might not be aware of, says Robin Gemmill, RN, MSN, CNS, professional practice leader of surgical oncology at City of Hope National Medical Center in Duarte, CA.

There is a misconception that people have surgery, the tumor is removed, and everything is fine, she says. However, with a cancer diagnosis, the treatment is not always so simple. Depending on the location of the tumor, surgery may not be an option. For example, if it were located too close to the heart, the surgery would be too risky.

The growth rate of the cells also determines if surgery is an option, says Gemmill. "Generally speaking, surgery is more successful if it is done on a slow-growing cancer vs. a very rapid-growing cancer, because you can’t get your hands on it so to speak," she explains. If the cancer cells might migrate and spread, surgery might not be an option.

Obviously, the physicians will look at the efficacy of whatever surgery they propose. It has a lot to do with the type of cancer that the patient has and what research studies have shown," says Gemmill. They will want to see if surgery on that type of tumor has been shown to be a "cure," or if it is a good treatment because it extends life, she says.

Of course, in order for the patient to make an informed decision, he or she will need to understand the purpose of the surgery. Is the goal to cure the cancer, or has it metastasized and therefore the surgery is a palliative treatment?

Patients need to understand the advantages as well as the disadvantages of surgery, says Gemmill. For example, the surgery might require the amputation of a limb or cause disfigurement. Some of the head and neck patients have to go through reconstructive types of surgery following their cancer operation. Yet surgery may also be recommended to ease pain and thus improve a patient’s quality of life.

Also important for patients to know is whether or not the surgery has long-term effects. For example, could it result in sexual dysfunction and incontinence? Anything that would impact the quality of life should be relayed to the patient to help him or her make an informed decision.

Education according to cancer type

Once a decision on surgery has been made education will depend on the type of cancer that is being treated. Some may go home with special equipment such as drains and need special care at home. "Generally, we like to get caregivers involved early so they have time to learn what they need to do because usually the patient doesn’t stay long in the hospital," says Gemmill.

When patients go home with equipment, hands-on learning is best with demonstration of the procedure followed by a successful return demonstration by the patient or caregiver. It helps to provide a video that they can take home with them or detailed handouts that give step-by-step instructions.

Nutrition education also is important early on to ensure that people are eating correctly because that helps with the healing process.

In addition, patients need to know how to manage pain following surgery and what to expect in the way of pain. Some surgeries such as lung cancer are painful because surgeons are cutting on a large area of tissue; and whenever you start getting into several tissue areas, you tend to have more pain, says Gemmill.

All surgery patients need to know about how to help prevent complications such as pneumonia. This involves learning how to cough and deep breathe.

Pre-op education works best because it gives people a chance to ask questions and helps with the surgery because if people are less anxious, they probably will do better after the operation, says Gemmill.

Patients need to know about expected recovery time both in and out of the hospital setting. This will help them make arrangements for needed help at home and deal with issues related to work and children. New, less-invasive technology has reduced the length of stay in most cases, she says. "Patients may even go home in 48 hours, depending on how well they do," Gemmill adds.

Cancer treatment often is a combination of several therapies. The patient may have chemotherapy or radiation to shrink the tumor before the surgery and that will impact recovery time. For example, the wound may heal more slowly. Sometimes chemotherapy or radiation follows surgery. Usually if a physician prescribes both treatments after surgery, chemotherapy will be first so that there is time for the wound to heal before radiation is administered to the area.

Source

For more information about educating patients on surgery for cancer treatment, contact:

  • Robin Gemmill, RN, MSN, Professional Practice Leadership for Surgical Services, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010. Telephone: (626) 359-8111, ext. 65550. E-mail: RGemmill@coh.org.