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How can a stoma change during chemotherapy?

As a stoma care nurse, one of the important aspects of caring for patients is understanding how a stoma may change as a result of chemotherapy. While stoma changes are a normal part of the post-operative recovery process, chemotherapy treatment can also impact the stoma in a number of ways.

Changes to the stoma shape and size:

Up to 92%1 of cancer patients experience weight loss, and therefore body changes, which can also impact the stoma size, shape and the peristomal plane.

Chemotherapy may also cause inflammation of the bowel leading to swelling and possibly ulceration of their stoma. This can be quite alarming for patients and offering reassurance is crucial.

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

  1. Provide education: Provide patients with education on what changes are normal during chemotherapy and what changes are abnormal and how to manage them.
  2. Monitor the stoma: Explain the importance of regularly monitoring their stoma for any changes in size, shape, colour, or texture.
  3. Encourage patients to monitor any weight changes and the impact this may have on their peristomal skin surface.
  4. Encourage skin care: Encourage patients to clean and protect the skin around the stoma to prevent irritation and breakdown. Making sure that ostomates know the signs of skin damage to look out for can help identify a pouch mis-fit and therefore allow swift changes to prevent further damage.
  5. Assess and adjust the pouching system: Encourage patients to contact you if they experience any changes or have any concerns. Offering a stoma assessment and appropriate adjustment of their pouching system will ensure a proper fit, mitigate leakages and therefore reassure the patient during already challenging times.

References

  • Hopkinson J, Kazmi C, Elias J, et al. (2020) Diet and weight management by people with nonmetastatic colorectal cancer during chemotherapy: mixed methods research. Colorect. Cancer 9(2), CRC16 https://doi.org/10.2217/crc-2019-0017
  • 28. Caillet P, Liuu E, Simon A et al. Association between cachexia, chemotherapy and outcomes in older cancer patients: a systematic review. Clin. Nutr. 36(6), 1473–1482 (2016).