The process of recovery after colorectal cancer surgery : patients' experiences and factors of influence

The aim of this thesis was to describe and compare how patients recovering from different forms of colorectal cancer surgery experience their postopera-tive recovery, general health, and anxiety, up to six months after surgery. In addition, the aim was to describe the influence of patient- and surgery-related factors on patient-reported recovery. Data was collected through questionnaires containing instruments measuring general health, trait and state anxiety, and recovery. Recruitment was made consecutively. In total, 176 patients chose to participate and received the questionnaires before surgery, on the day of discharge, and one and six months after surgery. In addition, information concerning patient character-istics and factors related to surgery were retrieved from the patients’ medical journals. Data was also collected through in-depth interviews one and six months after surgery with ten purposefully included patients. Postoperative recovery after colorectal cancer surgery was described as a pro-gressive process. Experiences of physical powerlessness, difficulties with food intake, altered bowel function, and dependence on others, were prominent and changed from being intense in the beginning of the process to gradually disappearing as time went by. On the day of discharge, no patient was considered fully recovered or almost fully recovered. Thereafter, it could be seen that patients after colonic resec-tion improved regarding the majority of symptoms connected to recovery al-ready during the first month after surgery, while patients after abdominoper-ineal resection deteriorated somewhat. Patients after rectal resection recovered better during the first month than those after an abdominoperineal resection but not as well as patients after colonic resection. Health was shown to be generally good preoperatively. One month after surgery, patients recovering from abdominoperineal resection and rectal resection had a temporary reduc-tion in health, while patients after a colonic resection had improved. Six months after surgery, health had improved to better than preoperative values without any differences between groups of patients. Regarding anxiety, both as a trait and as a state, this was shown to be low, without any differences between groups. Once at home from hospital, the patients experienced a continued difficulty with food intake, and the physical powerlessness made them initially de-pendent on relatives or friends in order to manage everyday life. The bowel function as well as the practical management of a possible stoma caused feel-ings of insecurity and concern. During the period from one month to six months after surgery, improvements were seen in symptoms connected to re-covery for all patients and especially after abdominoperineal resection. How-ever, it was also clear that patients after a rectal resection had not recovered to the same extent as those after an abdominoperineal or colonic resection. Some factors related to patient characteristics and surgery were shown to be associated with the odds for a good recovery one and six months after sur-gery. Those factors were age, grade of ASA, EQ VAS, EQ index, BMI, dura-tion of surgery, APR procedure, presence of stoma, LoS, and postoperative treatment. In addition, the dimensional levels of recovery could to a great ex-tent predict recovery in corresponding dimensions. The result of this thesis showed a diverse pattern of recovery. Nevertheless, there were also some similarities. This illustrates the complexity of postoper-ative recovery. In order to avoid unnecessary concerns, it is important for health care professionals to provide the patients with appropriate infor-mation and support throughout the whole recovery period and to design in-dividual follow-up strategies