: Wiley Blackwell; 2017

Ang SG, Chen HC, Siah RJ, He HG, Klainin-Yobas P Stressors relating to patient psychological health following stoma surgery: an integrated literature review. Oncol Nurs Forum. 2013; 40:(6)587-594

Anwar S, Peter MB, Dent J, Scott NA Palliative excisional surgery for primary colorectal cancer in patients with incurable metastatic disease. Is there a survival benefit? A systematic review. Colorectal Dis. 2012; 14:(8)920-930

National clinical guidelines. 2019;

Asteria CR, Nesi G, Minari C, Viganò P Defunctioning stoma in high ASA grade, aged patients, with bowel occlusion due to advanced cancer: is it still worthwhile?. Support Care Cancer. 2010; 18:(4)523-527

Bird A Mentioning the unmentionable: a stoma care nurse's journey to discussing sexuality comfortably with ostomates. Gastrointestinal Nursing. 2019a; 17:(3)

Bird A A dedicated stoma care counselling service to address the psychological needs of ostomates. Gastrointestinal Nursing. 2019b; 17:(10)

Bird A, Wilson K, Bertinara A, Amos L Educating patients in stoma care. Gastrointestinal Nursing. 2019; 17:(3)

Black P Selecting appropriate appliances and accessories for ileostomates. Gastrointestinal Nursing. 2015; 13:(7)

Borwell B Stoma management and palliative care. Journal of Community Nursing. 2011; 25:(4)4-10

Boyles A Patient outcomes and quality of life following stoma forming surgery. Gastrointestinal Nursing. 2010; 8:(8)30-35

Burch J Constipation and flatulence management for stoma patients. Br J Community Nurs. 2007; 12:(10)449-552

Burch J(ed). Chichester: Wiley-Blackwell; 2008

Burch J Examining stoma care guidance for nurses. Gastrointestinal Nursing. 2015; 13:(6)17-25

Burch J Research and expert opinion on siting a stoma: a review of the literature. Br J Nurs. 2018; 27:(16)S4-S12

Burke K The correlation between stoma siting by a stomal therapy nurse and the rate of post-operative complications and length of stay. Journal of Stomal Therapy Australia. 2017; 37:(4)10-12

Bowel cancer incidence by stage at diagnosis. 2017;

Costi R, Leonardi F, Zanoni D, Violi V, Roncoroni L Palliative care and end-stage colorectal cancer management: the surgeon meets the oncologist. World J Gastroenterol. 2014; 20:(24)7602-7621

Cronin E Stoma siting: why and how to mark the abdomen in preparation for surgery. Gastrointestinal Nursing. 2014; 12:(13)

Davenport R A proven pathway for stoma care: the value of stoma care services. Br J Nurs. 2014; 23:(22)1174-80

Elmessiry MM, Mohamed EA Emergency curative resection of colorectal cancer, do it with caution. A comparative case series. Ann Med Surg (Lond). 2020; 55:70-76

Ferguson HJ, Ferguson CI, Speakman J, Ismail T Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond). 2015; 4:(3)264-270

Foskett K The role of the colorectal and stoma clinical nurse specialist. Journal of Community Nursing. 2012; 26:(6)11-12

Grant M Creative arts therapy in stoma care: workshops exploring grief, body image and sexual intimacy. Gastrointestinal Nursing. 2019; 17:(2)

Han C, McKeage M Neuropathies associated with oxaliplatin therapy. Asia Pac J Clin Oncol. 2012; 8:(2)107-110

Hill B Stoma care: procedures, appliances and nursing considerations. Br J Nurs. 2020; 29:(22)S14-S19

Iacovelli R, Pietrantonio F, Palazzo A, Maggi C, Ricchini F, de Braud F, Di Bartolomeo M Incidence and relative risk of grade 3 and 4 diarrhoea in patients treated with capecitabine or 5-fluorouracil: a meta-analysis of published trials. Br J Clin Pharmacol. 2014; 78:(6)1228-1237

Lee L, Jacklin M, Boyer C Giving staff confidence to discuss sexual concerns with patients. Cancer Nursing Practice. 20111; 11:(2)28-32

Concerns checklist—identifying your concerns. 2018;

Mann CD, Norwood MG, Miller AS, Hemingway D Nonresectional palliative abdominal surgery for patients with advanced colorectal cancer. Colorectal Dis. 2010; 12:(10)1039-1043

McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K Chemotherapy-induced constipation and diarrhea: pathophysiology, current and emerging treatments. Front Pharmacol. 2016; 7

Mead E, Dowling M Management of metastatic colon cancer and its implications for patients and nurses. Cancer Nursing Practice. 2015; 14:(3)25-30

Nagashima Y, Funahashi K, Ushigome M Comparative outcomes between palliative ileostomy and colostomy in patients with malignant large bowel obstruction. J Anus Rectum Colon. 2019; 3:(2)73-77

Nagula S, Ishill N, Nash C Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg. 2010; 210:(1)45-53

Noone P Pre- and postoperative steps to improve body image following stoma surgery. Gastrointestinal Nursing. 2010; 8:(2)

Colorectal cancer update. [E3] Information needs of people prior, during and after treatment for colorectal cancer. NICE guideline NG151. Evidence reviews. 2020; 2020

Padman S, Lee J, Kumar R Late effects of oxaliplatin-induced peripheral neuropathy (LEON)—cross-sectional cohort study of patients with colorectal cancer surviving at least 2 years. Support Care Cancer. 2015; 23:(3)861-869

Robertson JP, Wells CI, Vather R, Bissett IP Effect of diversion ileostomy on the occurrence and consequences of chemotherapy-induced diarrhea. Dis Colon Rectum. 2016; 59:(3)194-200

Rust JA Complications arising from poor stoma siting. Gastrointestinal Nursing. 2011; 9:(5)17-22

Skipper G Temporary loop ileostomy or permanent end colostomy for low rectal cancer: making the right choice. Gastrointestinal Nursing. 2019; 17:(9)

Soveri LM, Lamminmäki A, Hänninen UA, Karhunen M, Bono P, Osterlund P Long-term neuropathy and quality of life in colorectal cancer patients treated with oxaliplatin containing adjuvant chemotherapy. Acta Oncol. 2019; 58:(4)398-406

Tan WJ, Chew MH, Tan IB Palliative surgical intervention in metastatic colorectal carcinoma: a prospective analysis of quality of life. Colorectal Dis. 2016; 18:(4)357-363

Thaysen HV, Jess P, Laurberg S Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer: a review. Colorectal Dis. 2012; 14:(7)797-803

Vonk-Klaassen SM, de Vocht HM, den Ouden ME, Eddes EH, Schuurmans MJ Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res. 2016; 25:(1)125-133

Wallace A, Taylor C Recognising how chemotherapy side effects can affect stoma care. Cancer Nursing Practice. 2011; 10:(2)20-25

Stoma formation as a palliative procedure: the role of the clinical nurse specialist in maintaining quality of life

25 March 2021
Volume 30 · Issue 6


More than half of patients diagnosed with colon cancer present at an advanced stage, and palliative treatment may involve stoma formation. A literature review was undertaken to determine the potential effects of stoma formation as a palliative procedure on a patient's quality of life, and to examine the role of the clinical nurse specialist in this situation. Limited literature was found on this specific subject, so established evidence surrounding stoma formation and quality of life was examined in relation to palliative care. The clinical nurse specialist provides expert knowledge that can help to limit stoma complications and is also able to conduct assessments that identify holistic concerns affecting quality of life. However, access to a clinical nurse specialist may be limited, particularly when surgery is performed as an emergency. There is the potential for research surrounding patient experiences that may improve service provision for this client group.

Colorectal cancer is the fourth most common cancer in the UK (Bowel Cancer UK, 2019). More than half of patients diagnosed with colorectal cancer in the UK present at an advanced stage, with 23–26% having metastases at diagnosis (Cancer Research UK, 2017). Bowel obstruction is a risk with advanced disease, with some patients presenting with this as their initial symptom.

In addition to people presenting with advanced disease, patients who have undergone treatment for colorectal cancer with a curative intent may require palliative treatment if their cancer recurs.

Stoma formation as a palliative procedure can have far-reaching implications for a patient's quality of life. However, while much has been written about the impact of stoma formation on quality of life, little literature focuses on the specific impact that this has on patients receiving palliative treatment.

A literature search was performed using the EBSCO, PubMed, Wiley and Cochrane databases using the terms stoma, palliative and quality of life. Studies predominantly focused on technical aspects of management (eg a comparison between stent insertion versus stoma formation or using a stent as a bridge to elective surgery) and measured outcomes in terms of length of life, duration of hospital stay and cost effectiveness (Nagula et al, 2010; Anwar et al, 2012). Studies that set out to explore patients' quality of life, again, focused on survival benefit measured in months (Anwar et al, 2012), or either only included patients undergoing elective procedures or excluded those undergoing palliative procedures altogether (Thaysen et al, 2012; Tan et al, 2016).

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