"Your daughter has ovarian cancer."
These are words that would shock any mother, no less a mother who is an oncology nurse. Noeline Young is a good friend of mine who has been practicing nursing in England for over 20 years. Her only daughter was 18-years-old when she heard these dreaded words following her daughter’s abdominal ultrasound for suspected gallstones.
The scan did not reveal gallstones but instead a large ovarian cyst with free fluid in the abdomen, thought to be possibly leaking from the cyst. Hannah was a fit and active teenager, a dance student and a happy, bright girl who had been diagnosed as with irritable bowel syndrome (IBS) two years earlier. This raised an alarm for Noeline whose clinical experience had taught her that for many women, the first symptom of ovarian cancer is IBS.
Following Hannah’s hospitalization for an oophorectomy, the frozen section indeed revealed stage 3 ovarian cancer. Hannah had to have a bilateral oophorectomy, small bowel resection, bladder resection, omentectomy and removal of peritoneal deposits.
Hannah’s surgery had been successful and all visual evidence of the cancer had been removed. However, the implications of the disease and the surgery were huge for such a young girl. The bilateral oophorectomy meant she would have a surgical menopause and would not be able to have children. There were also the inevitable concerns about cancer recurrence and metastases.
Hanna’s postoperative period was not without complications. Because the small bowel had been handled and resected Hannah had a paralytic ileus vomited each time she was moved despite a nasogastric tube in situ. She still had an epidural in place for pain control and needed help to move in bed. These were miserable days for Hannah however she wanted to be actively involved in her treatment and to be fully informed, even at her young age.
Hair loss was a very painful issue for her as she felt her long blonde hair expressed her individuality and style as well as her sexuality and that the loss of this and her fertility threatened this. However, she felt that if she remained fully informed, that she regained some level of control over the disease process.
Noeline’s experiences have made her challenge her beliefs and question many aspects of our lifestyle. She was angry with herself for accepting the diagnosis of IBS without question. A study by Goff et al (2000) found that 77% of patients showed abdominal symptoms before diagnosis of ovarian cancer. Although there is no reliable method to screen for ovarian cancer (Jacobs et al, 1993), she wonders whether a routine ultrasound scan for women with symptoms of IBS would help to identify ovarian cancer earlier.
Hannah made a remarkable recovery and the histology results showed only a very small focus of serous papillary carcinoma in both ovaries. The rest of the tumor was borderline and this improved the prognosis and treatment outcomes. Treatment decisions needed to be made quickly and Noeline reflects on how often we, as nurses, present patients with such scenarios, yet do not fully appreciate how difficult it is to assimilate information and make decisions when you are in a state of shock.
Hannah completed a long course of chemotherapy and has remained cancer free for over 3 years. Painful personal experiences often enable us to reflect on the care we offer as health professionals to patients diagnosed with cancer or other serious illnesses. Noeline explained to me that she feels that she is a much more empathetic and caring nurse following her experience, with a deeper understanding of the issues involved for patients facing serious illness.
Noeline’s story serves to highlight the need for patients to have access to someone who can offer emotional support along with information about treatment options, side effects and expected outcomes. Furthermore, it highlights the importance of specialized nursing roles where nurses trained in all aspects of a particular field such as oncology are incredibly effectively at caring for patients in a holistic manner and become a primary source of information, comfort and healing.