Breaking the taboo

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Annet Nicholls, Lawrence Mutale and Maria Stapleton are the friendly faces who will be guiding bowel cancer patients through their experience with the disease.

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It can be embarrassing for many patients, but colorectal cancer's also one of the most common, writes JANINE RANKIN. 

 If you're going to get cancer, the chances are high it will be some kind of bowel cancer.

Colorectal cancer is the second most common cancer among both men and women in New Zealand, and the third- biggest cancer killer.

Not that you'd know it, because it doesn't have the public profile many other kinds of cancer receive.

And the diagnosis is traumatic for people, says newly-appointed MidCentral Health lead colorectal cancer nurse specialist Maria Stapleton.

That reaction is not just about having cancer, but about having a cancer that affects what until that moment were such private functions.

"We need to break through the taboo," says Ms Stapleton.

From the time children are little, they're taught that what goes on behind the toilet door is private and not to be talked about, she says.

But for the patient with colorectal cancer, whole teams of health professionals are suddenly focused on the business of waste elimination, whether it involves surgery and a stoma with an ostomy bag, or internal repairs that also affect bowel management and function.

Ms Stapleton's role and that of two colleagues is to walk alongside patients going through the colorectal cancer experience, easing the transitions, making sure they understand what's happening, soothing anxiety and providing a consistent pillar of support.

The three nurses have been appointed to newly-created positions with MidCentral Health dedicated to smoothing the patient's experience from diagnosis, through treatment, to rehabilitation or palliative care.

Returning to the workforce in 2000, Ms Stapleton has worked as a stoma nurse, which involved meeting patients before surgery and teaching them how to manage ostomy bags and prepare them for discharge. That will still be part of her practical work with patients.

About 70 percent of the people she's met through stoma therapy work had cancer, and on a pathway that extends well beyond the hospital.

In her new role, her first contact might be when patients are referred for diagnostic tests, so she can support and inform them through that early part of the process, ensure they have information and understand it well enough to contribute to decisions about their treatment, and to be there for them afterwards.

"It's a very complex journey, with lots of information, and lots of different health professionals involved. They often get very good information, but can't absorb it all and take in everything at once."

The nurses will also do a stocktake to make sure patients are getting every help they need and are entitled to, whether it is psychological support, dietary advice, assistance with travel, or help at home when they are unwell.

"It's about wrapping the services around the patient, stopping the treadmill for a moment and looking at what's happening for them."

Although the colorectal nurses' role is new, it draws from the six years of experience built up by breast cancer clinical nurse specialist Cheryl MacDonald.

Other specialist nurses will be available to support patients with lung and respiratory cancers, leukaemia and other blood disorders.

Their role will be complemented by four community cancer care co- ordinators based in each of the four primary health organisations in the district.

While her job was based at MidCentral Health, Ms Stapleton said she would also assist cancer patients from the wider region during the time they were in Palmerston North for treatment.

The nurses also intended to extend their role into prevention and early detection, working with groups like the Cancer Society to improve public awareness of bowel cancer, the risks, the early symptoms, and the importance of putting aside embarrassment in the interests of catching the disease early when it's most treatable.