Editing Patient Pathways: Colon Cancer (section)

= Challenges faced by colon cancer patients during their treatment journey =

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== Challenges during diagnositc evaluation ==

Diagnosis of colon cancer can be a stressful and challenging time for patients. Support during this phase can significantly improve the patient’s emotional and physical condition. Patients with colon cancer face various difficulties during diagnosis, such as physical, psychological, financial and professional difficulties and lack of information.

'''Physical difficulties'''

'''Symptoms of the disease:''' blood in the stool is the first symptom of colon cancer, which can cause discomfort and anxiety. In addition, there may be discomfort during colonoscopy, prolonged fatigue and unexplained weight loss.

'''Psychological difficulties'''

Fear of cancer diagnosis, uncertainty about treatment: fear of possible complications and side effects of treatment. The process of emotional acceptance of a cancer diagnosis can be very stressful and challenging. The patient needs emotional support, which puts pressure on family and friends to provide support.

'''Social isolation:''' the feeling of isolation due to illness and the need for privacy.

'''Financial and professional difficulties'''

'''Absence from work:''' frequent medical examinations and treatments can cause absence from work, which can affect career and financial stability. The costs of diagnosis and treatment, insufficient health insurance.

'''Lack of information'''

Patients often have difficulty finding reliable and understandable information about the disease, diagnostic procedures, treatment options, and their rights.

'''Insufficiently clear communication with doctors:''' the complexity of medical terminology and lack of time during consultations can make it difficult to fully understand the diagnosis and treatment options.

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== Challenges during treatment ==

'''Physical difficulties'''

'''Lack of energy:''' constant fatigue and exhaustion due to treatment and hormonal

Bleeding during surgery, the appearance of infection in the wound area, non-healing of the wound (dehiscence), damage to the nerves of the small pelvis, which leads to difficulties with urination, stool or erectile function.

Scars from surgery can affect appearance and self-confidence.

'''Cardiovascular problems:''' hormonal imbalance can affect the work of the heart.

'''Hair loss:''' can occur due to radiotherapy or chemotherapy.

'''Skin problems:''' dry skin, itching or rash due to therapy.

'''Eye problems:''' Dry eyes or irritation from radiotherapy.

'''Metabolic problems:''' changes in metabolism due to hormone therapies.

'''Changes in weight:''' weight gain or loss due to hormonal changes.

'''Psychological difficulties'''

'''Fear and anxiety:''' fear of illness, treatment, side effects and uncertainty of outcome, anxiety related to regular check-ups and fear of recurrence.

'''Depression:''' feelings of hopelessness, loss of interest in everyday activities, isolation. Changes in body image: discomfort due to physical changes, such as scars or changes in weight.

'''Stress due to treatment:''' Psychological stress due to intensive treatments and their impact on everyday life.

'''Relationship with a partner:''' sexual problems, decreased libido and emotional distance due to illness.

'''Family Relationships:''' Tensions within the family due to stress, role changes and responsibilities.

'''Social Isolation:''' Withdrawal from social activities due to fatigue, discomfort, or fear of exposure to infection during therapy.

'''Financial and professional difficulties'''

Reduced ability to work due to fatigue, side effects of treatment and emotional problems.

'''Absence from work:''' frequent medical appointments and treatments that require absence from work, which can affect career and financial stability.

High costs of medicines, operations, therapies and other medical services, travel and accommodation costs for patients who have to travel to healthcare centers. Reduced income due to reduced work capacity or job loss. Ongoing costs associated with long-term follow-up and health maintenance.

'''Lack of information'''

The need to understand complex medical information and make informed decisions. Difficulties in making treatment decisions due to lack of reliable and understandable information or conflicting advice.

Ignorance of patient rights.

Lack of information about healthcare providers during treatment.

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== Challenges during rehabilitation and disease monitoring ==

'''Physical difficulties'''

'''Chronic fatigue:''' Feeling exhausted that lasts for weeks or months after the end of treatment.

'''Muscle weakness:''' Reduced muscle strength due to physical inactivity during treatment.

'''Postoperative pain:''' Pain that lasts after surgery.

'''Chronic pain:''' Pain that occurs due to nerve or other tissue damage during treatment.

'''Insomnia:''' Difficulty sleeping, which can be caused by stress, pain, or side effects of treatment.

'''Nightmares and anxiety:''' Problems with emotional stress that affect sleep quality.

'''Swelling:''' Usually in the arms or legs, caused by the removal of lymph nodes or radiation.

'''Psychological difficulties'''

'''Fear of recurrence:''' continued fear of cancer recurrence.

'''Anxiety and depression:''' psychological stress and emotional problems associated with the cancer experience.

'''Social isolation:''' reduced social interaction due to fatigue, anxiety, or other symptoms.

'''Financial and professional difficulties'''

'''Return to work:''' difficulties in returning to work due to physical and emotional limitations. The long-term financial burden associated with ongoing medical expenses.

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== Challenges during palliative care ==

The difficulties faced by patients with colon cancer in Croatia and their families during palliative care are multifaceted and cover several key aspects: Limited access to palliative care: There is a significant gap between the need for palliative care and available resources. Insufficient capacity of specialized palliative care providers.

'''Psychological challenges''' The psychosocial and emotional burden of patients and their families is often great. Family caregivers often experience high levels of stress and emotional distress. Cultural and ethical issues: reluctance to discuss end-of-life issues can hinder the provision of effective palliative care. Ethical challenges in decision-making and caregiving can also create additional stress for families and healthcare professionals.

'''Financial challenges''' The costs of care can be a significant burden for families, especially considering the long-term nature of palliative care. The financial pressure can further exacerbate the stress experienced by patients and their families, affecting their overall well-being and quality of life. Challenges with care coordination: effective palliative care requires coordination between different healthcare providers. In Croatia, there are challenges related to the coordination of care between hospitals, palliative care units and home care services. Addressing these challenges requires a comprehensive approach that includes improving access to palliative care, providing emotional and psychological support to families, addressing financial burdens, and ensuring effective care coordination. In addition, public education and awareness raising about the benefits of palliative care can help reduce cultural and ethical barriers.

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== Challenges patients face after completing treatment for colon cancer ==

'''Physical challenges'''

'''Fatigue:''' It is often present even after treatment is finished. It can be caused by chemotherapy, radiotherapy or the stress of battling cancer.

'''Changes in bowel function:''' Patients may experience long-term changes in bowel movements, including diarrhea, constipation, incontinence, or a feeling of incomplete emptying.

'''Pain and discomfort:''' Pain in the surgical area can last for a long time. Scars, internal scar tissue (adhesions), and postoperative complications can cause discomfort or pain.

'''Nutritional Deficiencies:''' Due to changes in the digestive system, some patients may have problems absorbing nutrients, which can lead to anemia or other nutritional deficiencies.

'''Neuropathy:''' Nerve damage caused by chemotherapy can lead to tingling, pain, or numbness in the hands and feet.

'''Lymphedema:''' If lymph nodes have been removed during surgery, swelling of the extremities may occur.

'''Complications with a stoma:''' If the patient has a colostomy or ileostomy, problems such as skin irritation, infection or difficulty adjusting to life with a stoma may occur.

'''Psychological challenges'''

Cancer survivors often experience anxiety and fear of the cancer coming back, which can affect their emotional well-being. They may also face adjustment difficulties after treatment, including changes to daily routines and life plans. The role of family members as caregivers often changes after treatment is completed. Their support remains crucial, but adjustments may be needed to the new circumstances and reduced intensity of care.

Lifestyle and prevention: patients are encouraged to adopt healthy lifestyle habits such as regular physical activity, a healthy diet, not smoking and stress management in order to improve health.

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