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The importance of improving awareness of colorectal cancer

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									NTCLINICAL
                                      UPDATE	




                                     The importance of improving
                                     awareness of colorectal cancer
                                     AUTHOR Claire	Jagot, is press and public relations officer,    Diagnosing colorectal cancer
                                     Colon Cancer Concern.                                          The symptoms of colorectal cancer depend upon the
                                     ABSTRACT	Jagot,	C.	(2004)	The	importance	of	improv-            stage of the disease and the part of the colon or rectum
                                     ing	awareness	of	colorectal	cancer.	Nursing Times;	100:	       affected. They may include the following:
                                     14,	30–31.                                                     ● A recent or persistent change of bowel habit, such as
                                     The function of the bowel and the incidence of bowel           feeling the need to go to the toilet more frequently or
                                     cancer are issues that we do not want to think about.          having looser stools;
                                     Embarrassment around the symptoms, ignorance, and              ● Passing blood or mucus from the rectum;
                                     fear, are barriers that need to be overcome in order to        ● Extreme tiredness or fatigue without an obvious cause;
                                     reduce the number of people affected by the disease.           ● Unexplained pain or a lump in the abdomen.
                                     Colon Cancer Concern’s awareness campaign aims to                 The main tests used in the diagnosis of the disease are
                                     start members of the public talking about this killer          flexible sigmoidoscopy, colonoscopy, and barium enema.
                                     disease and acting upon their concerns.                        Ultrasound and computerised tomography (CT) scans can
                                                                                                    also be used in further investigations of the disease, usu-
                                     Colorectal cancer is the UK’s second most common cause         ally for staging the cancer rather than in diagnosis.
                                     of cancer death but if caught early, it is one of the most        As yet in the UK there is no national screening pro-
                                     treatable forms of cancer. Some 35,000 people are diag-        gramme for colorectal cancer. However, the NHS is cur-
                                     nosed with colorectal cancer every year in the UK and          rently carrying out pilot studies to examine the best
                                     16,000 of this number will die from the disease (Cancer        method of screening the public to increase detection of
                                     Research UK, 2003).                                            the disease in its earlier stages.
                                       It remains the disease that people do not want to talk
                                     about. Therefore, this year Colon Cancer Concern (CCC),        Treatment
                                     the UK’s leading bowel cancer charity, is undertaking the      The most common form of treatment for colorectal can-
                                     most comprehensive awareness campaign in the history           cer is surgery. Here the surgeon will remove the portion
                                     of the disease and the charity.                                of the colon or rectum containing the cancer, together
                                                                                                    with a healthy margin of tissue either side of the tumour
                                     What is colorectal cancer?                                     and the surrounding lymph nodes to help reduce the
                                     Colorectal cancer, otherwise known as large bowel or           chances of the disease spreading or recurring.
                                     colon cancer, can develop within any part of the colon or        Some patients will have to undergo a course of chemo-
                                     rectum. It is a disease that most people in this country       therapy following surgery. Radiotherapy is used more
                                     know little or nothing about yet it will affect one in 20 of   commonly to treat cancer of the rectum and can be given
                                     us in our lifetime (Cancer Research UK, 2003).                 prior to and/or following surgery.
                                       Although the exact cause of colorectal cancer is
                                     unknown, there are several factors that make people            Reducing the risk of colorectal cancer
                                     more at risk:                                                  By making a few simple lifestyle changes, people can
                                     ● Colorectal cancer can develop in men and women of            help to reduce their risk of developing colorectal cancer.
                                     any age but it tends to be a disease of late middle age;       These changes include:
                                     ● In the UK, about 75 per cent of cases occur in people        ● Being aware of their bowel pattern, so people know
                                     over the age of 55 (Cancer Research UK, 2003);                 what is normal for them;
                                     ● In the UK, 5–10 per cent of all people diagnosed with        ● Trying to avoid constipation, as this slows down the
                                     colorectal cancer have a family history of the disease.        passage of waste products through the digestive system;
   NT CLINICAL is an essential       Often if there is a history of colorectal cancer within a      ● Eating a healthy diet that is low in fat and high in

          resource for extending     family, the disease appears at an earlier age – under the      fibre, including at least five portions of fresh fruit and
                                     age of 45 (Cancer Research UK, 2003);                          vegetables a day;
   your knowledge base. You
                                     ● People who have an inflammatory bowel disease,               ● Drinking plenty of fresh fluids, water in particular;
                can achieve your     such as Crohn’s disease or ulcerative colitis, or those who    ● Exercising regularly to keep healthy.
          continuing professional    have had polyps removed in the past, may be at an                 These key facts highlight the importance of under-
              development PREP       increased risk;                                                standing why raising awareness needs to be taken seri-
                                     ● Consuming a diet that is high in fat and low in vegeta-      ously. Colorectal cancer can affect anyone. It is a common
   requirements by reflecting        bles, combined with an inactive lifestyle, can increase        disease but simple lifestyle changes can reduce the risk
                on these articles.   the risk of developing the disease.                            and it is highly treatable.



   00                                                                                                          NT 6 April 2004 Vol 100 No 14 www.nursingtimes.net
                                                                                  KEYWORDS        ■   Public health ■ Colon cancer ■ Awareness campaign




   One of the ironies surrounding colorectal cancer is that      CCC is also relying on the help of staff in GP surgeries,     REFERENCE
the number of deaths could so easily be reduced if peo-        councils and workplaces to help spread its messages by          Cancer Research UK (2003) Cancer
ple acted on their symptoms earlier and helped identify        putting up posters, distributing leaflets, and utilising the    Research UK Statistics, April 2003.
the disease in its early stages. If caught early, colorectal   intranet and other resources.                                   London: Cancer Research UK.
cancer is one of the most treatable forms of cancer.             Flagship campaigns that are aimed at achieving the
However, embarrassment, ignorance, and the fear that           media attention and coverage the disease deserves
surrounds the disease stop some people from acting             include the following:
upon their symptoms in time.                                   ● The launch of Bowel Cancer Awareness Month at the
   Recent research has indicated that 84 per cent of the       House of Lords on 1 April;
UK population does not act on their symptoms by going          ● Men’s Health Week in June;
to talk to their doctor, even when they have concerns.         ● CCC’s pub campaign in September.
Furthermore, most people in this country know little or          CCC’s regional campaigns, such as those in Scotland in
nothing about colorectal cancer and some do not even           September, will also enable local media coverage and
know where their colon is. Some avoid going to their GP        awareness throughout the UK.
because they are fearful of the diagnostic tests they will
have to undergo. Sometimes people may be even more             Implications for nurses
fearful of the tests than they are of the disease itself       While this campaign is a public awareness campaign, CCC
(Cancer Research UK, 2003).                                    recognises that it would not be possible without the sup-
   Dave Miners, a patient with CCC who recently appeared       port of health care professionals.
on BBC Breakfast, sums things up perfectly: ‘I am abso-          Partnership with nurses is essential to the campaign’s
lutely convinced that we don’t talk about bowel cancer         successful roll-out as they play a vital role in offering
because of the English reticence; the British stiff upper      information about the disease and responding to the
lip. Bowels are something that we don’t want to talk           reaction that is likely to be generated by the public.
about or think about but we must if we are going to              Nurses need to be able to respond to concerns that
tackle this dreadful disease.’                                 members of the public may have and to filter through
                                                               those individuals whose concerns require more attention.
CCC’s awareness campaign                                       Specialist nurses working on the charity’s trailer will also
Colon Cancer Concern believes that its upcoming aware-         be on hand to talk to the public during awareness visits.
ness campaign will help to overcome this reticence and           Any health care professional – whether working with
make colorectal cancer a subject that people are com-          CCC on the campaign or reacting to increased public
fortable discussing.                                           awareness – will be supported by CCC’s infoline, which is
  The campaign aims to reach an estimated audience             staffed by colorectal, oncology and stoma nurses. As well
of 17 million people. It is being launched during Bowel        as being a source of information, advice and support for
Cancer Awareness Month (April 2004) and has been               patients, the infoline is also there to provide more in-
made possible, in part, by National Lottery funding of         depth information if required (Box 1).
over £200,000.                                                                                                                 FURTHER READING
  Focusing on public awareness, the campaign will target       Working with government                                         Borwell, B. (2002) Bowel cancer in the
GPs’ waiting rooms, pubs, gyms, councils and large             The government’s commitment to a national screening             older person. Gastrointestinal nursing;
employee workplaces – in order to reach as wide an             programme and to improving treatments and services,             November, 32–33.
audience as possible.                                          through the NHS Bowel Cancer Programme, is a sign that
  Eye-catching slogans, such as ‘Don’t blush. Look before      colorectal cancer is, at last, receiving the recognition that   CancerBACUP (2000) Understanding
you flush’, will be sure to capture the public’s attention     it deserves.                                                    Cancer of the Colon and Rectum.
as the campaign is rolled out throughout the year. CCC’s          However, it is also an indication that more still needs      London: CancerBACUP.
45-foot trailer, which will act as its ‘mobile surgery’ for    to be done. Survival rates of colorectal cancer are low in
                                                                                                                               De Snoo, L. (2002) Colorectal Cancer.
the campaign, will be touring the country and is some-         the UK in relation to other European countries. There is
                                                                                                                               Cancer Nursing Practice; 1: 10, 32–38.
where the public can visit to learn about the disease and      currently only one first-line drug available for most
talk to nurses or CCC representatives.                         bowel cancer patients in the UK – fluorouracil. In com-         Jones, D.J. (2000) ABC of Colorectal
                                                               parison a number of drugs to treat bowel cancer are             Diseases. London: BMJ Publishing
  BOX	1.		FURTHER	INFORMATION                                  available in other European countries.                          Group.
                                                                  Colon Cancer Concern will be working with and lobbying
  ● For further information on CCC’s awareness                 the government to ensure that colorectal cancer is kept         Porrett, T., Daniels, N. (1999) Essential
  campaign or its nurse education programme, call              high on the political agenda and that recent screening          Coloproctology for Nurses. London:
  020 7381 9711.                                               and treatment commitments are not forgotten.                    Whurr Publishers Ltd.
                                                                  It is important to keep up the momentum of cam-
  ● For further information on colorectal cancer,
  contact CCC’s infoline service on 08708 506050.              paigning to raise awareness and improve services at this        This article has been double-blind
                                                               level as this complements the charity’s efforts to raise        peer-reviewed.
  ● Alternatively, visit the CCC website on www.               awareness ‘on the ground’ and helps to ensure that              For related articles on this subject
  coloncancer.org.uk                                           patients are able to obtain access to the treatment and         and links to relevant websites see www.
                                                               services that they deserve. ■                                   nursingtimes.net



NT 6 April 2004 Vol 100 No 14 www.nursingtimes.net                                                                                                                     31

								
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