ARRIVING HOME AFTER CANCER SURGERY can be a jarring experience and presents both practical and psychological challenges. The Agency for Healthcare Research and Quality notes, “The transition from hospital to home can be challenging as patients and families become responsible for care coordination.” However, cancer patients’ best advantage for post-surgery healing at home may well be the preparation they initiate themselves.
Alyssa Middleton, founder and president of MyCancerResources.com, in Louisville, Kentucky, encourages cancer patients to delegate all their regular chores and responsibilities to family members and friends for two weeks following hospital discharge. “A patient’s entrusting these critical tasks to others typically goes hand in hand with having a solid plan in place, ideally organized prior to admission to [the] hospital,” she says.
“A significant issue I see is that patients, post-surgery, have so greatly underestimated their pain, nausea and fatigue that they are unable to complete even simple tasks, such as grocery shopping, driving and taking care of paperwork, which they thought would be easy to handle,” she says. Middleton, who coaches cancer patients and their caregivers adds, “Not having assigned such tasks to others can lead to stress, anxiety and trying to push through pain, which at a physical level may even cause stitches to rip, further compromising recovery time.”
Although cancer patients can smooth the path to recovery by creating a return-home protocol, many patients have trouble preparing for life after surgery. Some have difficulty reaching out to others in advance. “The reason for such inaction is typically that cancer patients, prior to surgery, are overwhelmed by the surgery itself and what the surgeon may discover during the operation,” says Steven Tovian, a clinical psychologist who works with cancer patients and teaches at Northwestern University Feinberg School of Medicine in Chicago.
Tovian says patients are often too distracted by worries about the surgery and that focusing on things they can do to protect their well-being, including making preparations for their recovery, can help relieve some of their stress. “By shifting the locus of control back to patients, they are better equipped psychologically to organize their return-home protocol, with all contingencies in place,” he says. “It’s a way for patients to see they are doing something good for themselves.”
Taking such steps does not always eliminate psychological distress. “For many people, the shock of a cancer diagnosis and having surgery is also the shock of potential dependency, and also of creating a storm of psychological issues,” says Kathleen Cairns, a psychologist in private practice in West Hartford, Connecticut. “The thought of not being able to care for oneself is especially difficult for people who have lived independently or in a solitary space, because they are not used to asking for or receiving help, or even navigating these prospects,” she says. “It can be embarrassing to reveal need when one wants to be self-reliant.”
Cairns suggests this issue may be compounded when the person has cordial ties with people who have not yet become friends. “Cancer patients may have good reason to fear their requests for help may go unanswered, so they think it may be safer not to ask for help at all,” she says. For other patients, maintaining privacy is paramount, so the risk of revealing their diagnosis may trigger upsetting feelings.
Because anxiety tied to impending surgery often derails return-home planning, family members or caregivers may need to address issues that arise after the patient has been discharged from the hospital. “Normalizing and acknowledging the experience of how post-surgery patients feel, especially regarding a weakened physical state, while also noting there’s no shame or stigma tied to not having prepared for the return home can be beneficial,” says Middleton of MyCancerResources.com.
A favorite strategy for Middleton is to give at-home recovering cancer patients overwhelmed by undelegated tasks three “task” options: those that are absolutely necessary, those that would be nice to accomplish, and those that can wait. “Giving patients the ability to prioritize a task with family members or friends helps create patient autonomy and a sense of control that they often feel has been lost,” Middleton says.
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