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Dexterity – a hidden challenge of chemotherapy for ostomates?

As a stoma care nurse, one of the hidden challenges you may encounter when caring for patients undergoing chemotherapy is dexterity issues. Chemotherapy can cause a range of side effects, such as Peripheral Neuropathy and Palmar Planter Erythrodysesthesia (hand-foot syndrome), which can make it difficult for patients to manage their ostomy.

Up to 40%1 of patients undergoing chemotherapy develop peripheral neuropathy or hand-foot syndrome.

Neuropathy, or nerve damage, can cause numbness, tingling, and weakness in the hands and feet. This can make it difficult for patients to handle small, or not as mouldable ostomy supplies. Similarly, hand-foot syndrome, a condition that causes swelling, sometimes blistering leading to pain on the palm of the hands and/or soles of the feet, can make it difficult for patients to grip and manipulate ostomy products.

As a stoma care nurse, it’s important to be aware of these dexterity challenges and to provide patients with the necessary support and advice to help them manage their ostomy during chemotherapy. Here are a few tips and advice to help patients manage their ostomy while experiencing dexterity issues:

Education

Provide education on alternative products: There are a variety of ostomy products available, such as pre-cut baseplates, easy-to-use 2-piece pouching systems designed for dexterity, mouldable products and adhesive removers in wipes rather than spray form that may be easier for ostomates to use. 

Support

Although self-care and independence are preferable, encourage patients to seek help from family members if they are struggling during their chemotherapy cycles. If support from a carer is not an option offer to point them in the direction of community-based nurses who can assist with pouch changes, particularly during difficult times.

Weartime

Consider use of longer wear time adhesive pouches or baseplates which require less changes.

Higher capacity

Consider increasing the pouch size could allow extra time for the patient to reach a bathroom, particularly if purging is an issue or if they are experiencing issues with mobility. Changing from a mini or standard pouch to a maxi could give that extra bit of time between emptying or changing the pouch.

Easy to use options

If an ostomate is struggling to cut their pouch precisely due to dexterity issues pre-cut baseplates could also be an option. In addition a highly mouldable, easy to use seal around the stoma as a preventative measure against leaks could help if baseplates are inaccurately sized due to dexterity challenges.

It’s important to remember that each patient may have different needs and that an individualised approach is essential. By working closely with patients, providing education and support, and coordinating with other healthcare providers, you can help patients manage their ostomy during chemotherapy and prevent additional problems occurring. 

References

Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. (2008) Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer. 2008;44(11):1507-1515. doi:10.1016/j.ejca.2008.04.018