The sense of well-being in a group of patients with gastro-intestinal cancer

The main purpose of this study was to describe patients with gastrointestinal cancer and their general health and well-being during different stages of the disease. Questionnaires concerning coping ability, general health, well-being and the frequencies and occurrences of symptoms were used to collect data about the patient's pre- and post-surgical situation. Two of these questionnaires, the Health Index (Hl) and the General Health Rating Index (GHRI), were addressed to a randomly selected sample from Stockholm County, in order to obtain the reference values of healthy individuals. Ninety-six patients with gastro-intestinal cancer were examined before surgery. Of these, 79 were available for examination six weeks after surgery. One year after surgery, 69 patients remained in the study.

The patients evaluated their well-being as rather good, both before and after surgery, although they reported symptoms such as flatulence, fatigue, sleep disorders, worry and pain. The first period at home, after discharge from the hospital, seems to be a critical period for the patients. Problem areas identified concerned fatigue, decreased energy and mobility, sleeping disorders, pain, nutrition, worry and wound problems. One year after surgery, the patients had not returned to a state of normal health. The cancer patients perceived their well-being and general health as worse than those of healthy individuals. The younger group of cancer patients rated their psychological well-being as worse one year after surgery, compared with that of the older ones. The intercorrelations between the Sense of Coherence (SOC), the HI and the GHRI were significant. Thus, the stronger the SOC, the better the perceived well-being and general health. No significant difference was found between the SOC score before and one year after surgery.

It was concluded that both the Hl scale and the SOC scale should be tested for clinical use in assessing the need of nursing care of patients with gastro-intestinal cancer. The SOC may be useful as an indicator of the individual's ability to manage his or her self-care after the treatment. The patient treated for gastro-intestinal cancer needs long-term, individualised support, with emphasis on psychosocial factors, bowel function and fatigue. Social and marital status apparently affect the patients' sense of well-being. A social network may function as a buffer against the discomfort of having a cancer disease and improve the individual's sense of well-being.