Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Marking Time: The Temporal Experience of Gastrointestinal Cancer

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Marking Time: The Temporal Experience of Gastrointestinal Cancer

Article excerpt

This paper explores the experience and management of bowel, pancreatic and oesophageal cancer. Bowel cancer is the second most common cancer in New South Wales (NSW), Australia. Pancreatic cancer is the eleventh most common cancer diagnosed, while oesophageal cancer is ranked nineteenth (Cancer Institute NSW, 2007a, 2007b, 2007c). This paper aims to use fresh and vivid accounts of the diagnosis and surgical management of gastrointestinal cancer as experienced and embodied within the life-world of patients and families. It is hoped this will lead to new understandings that will inform meaningful improvements in patient care.

BACKGROUND

A number of researchers have used qualitative methodologies to explore the experience of living with gastrointestinal cancer. A diagnosis of colorectal or oesophageal cancer causes disruption in the ill person and caregiver's life (Andreassen, Randers, Näslund, Stockeld, & Mattiasson, 2006; Houldin, 2007) and the pre-operative period is characterised by fear, questions, isolation and uncertainty (Pascal & Endacott, 2010; Taylor, 2001; Worster & Holmes, 2008). Colorectal patients, particularly those from rural areas, may experience a number of barriers to specialist referral (Bain & Campbell, 2000). Subsequent delays of investigations and timely communication of test results leads to greater anxiety (Bain, Campbell, Ritchie, & Cassidy, 2002; Thurston, Perry, & Kirby, 2003). In the early postoperative period patients struggle with loss of dignity and body control (Jonsson, Stenberg, & Frisman, 2010; Taylor, Richardson, & Cowley, 2010; Worster & Holmes, 2009).

People with oesophageal cancer experience a myriad of challenges to their sense of self (Clarke, McCorry, & Dempster, 2010). Dysphagia and fatigue shape the experience of oesophageal cancer (Andreassen et al., 2006) and the illness affects the whole family (Andreassen, Randers, Nasland, Styockeld, & Mattiasson, 2005). People tend to resign themselves to the risks of surgery, nurturing beliefs around surgical cure, and idealised medical expertise (McKneally & Martin, 2000). Surgery for oesophageal cancer changes the embodied sensations of hunger, satiety, swallowing, taste, and smell, rendering the previously taken-for-granted experience of eating alien (Wainwright, Donovan, Kavadas, Cramer, & Blazeby, 2007). Little qualitative work is published in the field of pancreatic surgery, but it is known patients with pancreatic cancer suffer high rates of major depression (Mayr & Schmid, 2010), and where surgery is indicated, it improves both survival and quality of life (Crippa et al., 2008).

Even though there may be a curative intent to surgery, the greatest source of anxiety for people with gastrointestinal cancer is fear of the cancers recurrence (Worster & Holmes, 2009), and this is also true for people experiencing other types of cancer (Pascal, 2010). According to the Cancer Institute of NSW, the combined 5 year relative survival for males and females diagnosed with oesophageal cancer is 17%, while pancreatic cancer is less than 10%. The 5 year survival rate for colorectal cancer is reported to be 65% for males and 66% for females (Cancer Institute NSW, 2010).

METHODS

This paper employs the writings of Heidegger, not only to provide a research methodology, but also a philosophical framework that guides a way of understanding being with gastrointestinal cancer. Drawing on Heidegger's philosophy allows an existential and ontological perspective that frames experience around the condition of human existence and being. Existentialism considers an individual's emotions, actions, responsibilities, and thoughts in the creation of individual meanings (Macquarrie, 1972).

Historically, biomedical research methods are aligned with the philosophy of René Descartes which sees the mind as being thoroughly distinct from the physiological functions of the body (Descartes, 1640/1904, p. …

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