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“How do you live without a stomach?”: A multiple case study examination of total gastrectomy for palliation or prophylaxis

Published online by Cambridge University Press:  15 August 2011

Sheila N. Garland ,
Joshua Lounsberry ,
Guy Pelletier  and
Oliver F. Bathe
Sheila N. Garland*
Affiliation:
Department of Psychology, University of Calgary, Calgary, Alberta, Canada Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
Joshua Lounsberry
Affiliation:
Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
Guy Pelletier
Affiliation:
Department of Psychology, University of Calgary, Calgary, Alberta, Canada Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada Department of Oncology, University of Calgary, Calgary, Alberta, Canada
Oliver F. Bathe
Affiliation:
Department of Oncology, University of Calgary, Calgary, Alberta, Canada Department of Surgery, University of Calgary, Calgary, Alberta, Canada
*
Address correspondence and reprint requests to: Sheila N. Garland, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4. E-mail: sngarlan@ucalgary.ca
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Abstract

Objective:

The number of diagnosed cases of stomach cancer in Western countries is relatively small compared to prevalence rates in Eastern populations. This disparity creates a general lack of information and understanding of the experience of patients treated for this disease in North America. Surgical removal of the stomach, also called total gastrectomy (TG), is presently the only curative treatment available to patients with stomach cancer. Considering the impact such a procedure may have, very little is known about what factors influence an individual's postsurgical quality of life (QL).

Method:

This article reviews current literature and examines three unique case studies. Semi-structured interviews were analyzed using content analysis, a qualitative analytic approach for reporting combined subject responses.

Results:

Participants included one 37-year-old man with multiple polyps in his stomach and a family history of stomach cancer, one 18 year-old man with a confirmed CDH1 mutation and a family history of stomach cancer, and one 33-year-old man with confirmed metastatic gastric adenocarcinoma. Subjective patient experience was categorized into: (1) making the decision, (2) treatment impact, and (3) life after TG. Prior to surgery, all patients carefully evaluated their perceived risk compared to the treatment consequences and indicated that a certain event triggered their decision. The largest treatment impacts were learning to eat again and adjusting to the physical changes. Each patient endorsed that their experience made them appreciate and make the most of life.

Significance of results:

This currently represents the only study to investigate the lived experience of TG for prophylaxis or palliation in individuals with and without genetic risk for stomach cancer. Understanding this process will allow all members of the cancer care team, and the patients themselves, to better understand the factors involved in decision making and postoperative adjustment. Fruitful avenues for future research are discussed.

Keywords

CancerQLStomach neoplasmsTGMedical decision makingQuality of lifeTotal gastrectomy
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 3 , September 2011 , pp. 305 - 313
Copyright
Copyright © Cambridge University Press 2011

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