The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants’ view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities. 1. Introduction This paper reports an inside perspective of persons who underwent pancreatic cancer surgery. It adds new knowledge about the needs and preferences of this group of surgical patients and the nursing interventions required to promote postoperative recovery and health. Pancreatic cancer is a relatively rare type of gastric cancer with high mortality. In 2008, there were 144,859 cases of pancreatic cancer in the world [1], of which approximately 37,680 were in the United States [2]. In Sweden, 1,250 cases of pancreatic and periampullary tumours were reported in 2010 [3]. Median survival following curative treatment by surgery and adjuvant therapy was 20.1–23.6 months, while median survival with palliative treatment was 5–9 months [4]. Five-year survival was less than 5% [5]. About 90% of all pancreatic tumours originate in the exocrine part of the pancreas and are usually localised to the pancreatic head (caput). These tumours generally manifest earlier than those in distal parts of the gland due to jaundice related to obstruction of the bile duct. Periampullary cancer includes tumours in ampulla vateri, distal bile
References
[1]
International Agency for Resaerch in Cancer, “GLOBOCAN 2008,” World Health Organisation, 2008, http://globocan.iarc.fr/.
[2]
A. Jemal, R. Siegel, E. Ward et al., “Cancer statistics, 2008,” CA Cancer Journal for Clinicians, vol. 58, no. 2, pp. 71–96, 2008.
[3]
“Cancer incidence in Sweden 2010,” Swedish National Board of Health and Welfare, 2011.
[4]
S. Gillen, T. Schuster, C. M. Z. Büschenfelde, H. Friess, and J. Kleeff, “Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages,” PLoS Medicine, vol. 7, no. 4, Article ID e1000267, 2010.
[5]
A. Vincent, J. Herman, R. Schulick, R. H. Hruban, and M. Goggins, “Pancreatic cancer,” The Lancet, vol. 378, no. 9791, pp. 607–620, 2011.
[6]
J. M. Sarmiento, D. M. Nagorney, M. G. Sarr, and M. B. Farnell, “Periampullary cancers: are there differences?” Surgical Clinics of North America, vol. 81, no. 3, pp. 543–555, 2001.
[7]
M. Wagner, C. Redaelli, M. Lietz, C. A. Seiler, H. Friess, and M. W. Büchler, “Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma,” British Journal of Surgery, vol. 91, no. 5, pp. 586–594, 2004.
[8]
M. K. Diener, C. Heukaufer, G. Schwarzer et al., “Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD006053, 2008.
[9]
E. A. Holly, I. Chaliha, P. M. Bracci, and M. Gautam, “Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area,” Clinical Gastroenterology and Hepatology, vol. 2, no. 6, pp. 510–517, 2004.
[10]
C. C. Reyes-Gibby, W. Chan, J. L. Abbruzzese et al., “Patterns of self-reported symptoms in pancreatic cancer patients receiving chemoradiation,” Journal of Pain and Symptom Management, vol. 34, no. 3, pp. 244–252, 2007.
[11]
J. J. Huang, C. J. Yeo, T. A. Sohn et al., “Quality of life and outcomes after pancreaticoduodenectomy,” Annals of Surgery, vol. 231, no. 6, pp. 890–898, 2000.
[12]
R. L. Krech and D. Walsh, “Symptoms of pancreatic cancer,” Journal of Pain and Symptom Management, vol. 6, no. 6, pp. 360–367, 1991.
[13]
V. Sun, B. Ferrell, G. Juarez, L. D. Wagman, Y. Yen, and V. Chung, “Symptom concerns and quality of life in hepatobiliary cancers,” Oncology Nursing Forum, vol. 35, no. 3, pp. E45–E52, 2008.
[14]
U. Olsson, I. Bosaeus, and I. Bergbom, “Patients' experiences of the recovery period 12 months after upper gastrointestinal surgery,” Gastroenterology Nursing, vol. 33, no. 6, pp. 422–431, 2010.
[15]
D. Fitzsimmons, S. George, S. Payne, and C. D. Johnson, “Differences in perception of quality of life issues between health professionals and patients with pancreatic cancer,” Psycho-Oncology, vol. 8, no. 2, pp. 135–143, 1999.
[16]
E. J. M. N. Van Dijkum, K. F. D. Kuhlmann, C. B. Terwee, H. Obertop, J. C. J. M. De Haes, and D. J. Gouma, “Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma,” British Journal of Surgery, vol. 92, no. 4, pp. 471–477, 2005.
[17]
A. G. Patel, M. T. Toyama, A. M. Kusske et al., “Pylorus-preserving Whipple resection for pancreatic cancer: is it any better?” Archives of Surgery, vol. 130, no. 8, pp. 838–843, 1995.
[18]
B. Schniewind, B. Bestmann, D. Henne-Bruns, F. Faendrich, B. Kremer, and T. Kuechler, “Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head,” British Journal of Surgery, vol. 93, no. 9, pp. 1099–1107, 2006.
[19]
C. A. Seiler, M. Wagner, T. Bachmann et al., “Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection—long term results,” British Journal of Surgery, vol. 92, no. 5, pp. 547–556, 2005.
[20]
P. Ricoeur, Interpretation Theory: Discourse and the Surplus of Meaning, Texas Christian University, 1976.
[21]
P. Ricoeur, Oneself as Another, University of Chicago Press, London, UK, 1994.
[22]
A. Lindseth and A. Norberg, “A phenomenological hermeneutical method for researching lived experience,” Scandinavian Journal of Caring Sciences, vol. 18, no. 2, pp. 145–153, 2004.
[23]
CODEX, “Ethical Review of Research,” Uppsala, Sweden, 2012, http://www.codex.vr.se/en/manniska5.shtml.
[24]
World Medical Association, “Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects,” 2008, http://www.wma.net/en/30publications/10policies/b3/index.html.
[25]
R. Elmir, D. Jackson, B. Beale, and V. Schmied, “Against all odds: Australian women's experiences of recovery from breast cancer,” Journal of Clinical Nursing, vol. 19, no. 17-18, pp. 2531–2538, 2010.
[26]
M. Kelly and M. Dowling, “Patients' lived experience of myeloma,” Nursing Standard (Royal College of Nursing (Great Britain): 1987), vol. 25, no. 28, pp. 38–44, 2011.
[27]
K. A. Krumwiede and N. Krumwiede, “The lived experience of men diagnosed with prostate cancer,” Oncology Nursing Forum, vol. 39, pp. E443–E450, 2012.
[28]
L. E. McCahill and B. P. Hamel-Bissell, “The patient lived experience for surgical treatment of colorectal liver metastases: a phenomenological study,” Palliative and Supportive Care, vol. 7, no. 1, pp. 65–73, 2009.
[29]
K. M. Brintzenhofe-Szoc, T. T. Levin, Y. Li, D. W. Kissane, and J. R. Zabora, “Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type,” Psychosomatics, vol. 50, no. 4, pp. 383–391, 2009.
[30]
K. L. Clark, M. Loscalzo, P. C. Trask, J. Zabora, and E. J. Philip, “Psychological distress in patients with pancreatic cancer—an understudied group,” Psycho-Oncology, vol. 19, no. 12, pp. 1313–1320, 2010.
[31]
J. Zabora, K. Brintzenhofeszoc, B. Curbow, C. Hooker, and S. Piantadosi, “The prevalence of psychological distress by cancer site,” Psycho Oncology, vol. 10, no. 1, pp. 19–28, 2001.
[32]
R. Allvin, K. Berg, E. Idvall, and U. Nilsson, “Postoperative recovery: a concept analysis,” Journal of Advanced Nursing, vol. 57, no. 5, pp. 552–558, 2007.
[33]
R. Allvin, M. Ehnfors, N. Rawal, and E. Idvall, “Experiences of the postoperative recovery process: an interview study,” The Open Nursing Journal, vol. 2, pp. 1–7, 2008.
[34]
B. Gustafsson and W. Wiik, Bekr？ftande Omv？rdnad: SAUK-Modellen f？r V？rd Och Omsorg, Studentlitteratur, Lund, Sweden, 2nd edition, 2004.
[35]
M. Dodd, S. Janson, N. Facione et al., “Advancing the science of symptom management,” Journal of Advanced Nursing, vol. 33, no. 5, pp. 668–676, 2001.
[36]
E. R. Lenz, L. C. Pugh, R. A. Milligan, A. Gift, and F. Suppe, “The middle-range theory of unpleasant symptoms: an update,” Advances in Nursing Science, vol. 19, no. 3, pp. 14–27, 1997.
[37]
A. Forsberg, L. B？ckman, and A. M？ller, “Experiencing liver transplantation: a phenomenological approach,” Journal of Advanced Nursing, vol. 32, no. 2, pp. 327–334, 2000.
[38]
N. A. Hodgson and C. W. Given, “Determinants of functional recovery in older adults surgically treated for cancer,” Cancer Nursing, vol. 27, no. 1, pp. 10–16, 2004.
[39]
N. M. Spector, F. D. Hicks, and J. Pickleman, “Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study,” Gastroenterology Nursing, vol. 25, no. 3, pp. 120–125, 2002.
[40]
D. Wainwright, J. L. Donovan, V. Kavadas, H. Cramer, and J. M. Blazeby, “Remapping the body: learning to eat again after surgery for esophageal cancer,” Qualitative Health Research, vol. 17, no. 6, pp. 759–771, 2007.
[41]
E. M. L. Verschuur, E. W. Steyerberg, E. J. Kuipers et al., “Experiences and expectations of patients after oesophageal cancer surgery: an explorative study,” European Journal of Cancer Care, vol. 15, no. 4, pp. 324–332, 2006.
[42]
L. E. McCahill and B. P. Hamel-Bissell, “The patient lived experience for surgical treatment of colorectal liver metastases: a phenomenological study,” Palliative and Supportive Care, vol. 7, no. 1, pp. 65–73, 2009.
[43]
I. McCarthy and M. Dowling, “Living with a diagnosis of non-small cell lung cancer: patients' lived experiences,” International Journal of Palliative Nursing, vol. 15, no. 12, pp. 579–587, 2009.
[44]
P. R. Ebright and B. Lyon, “Understanding hope and factors that enhance hope in women with breast cancer,” Oncology Nursing Forum, vol. 29, no. 3, pp. 561–568, 2002.
[45]
B. E. Felder, “Hope and coping in patients with cancer diagnoses,” Cancer Nursing, vol. 27, no. 4, pp. 320–324, 2004.
[46]
C. C. Lin, Y. L. Lai, and S. E. Ward, “Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients,” Journal of Pain and Symptom Management, vol. 25, no. 1, pp. 29–37, 2003.
[47]
J. L. Mattioli, R. Repinski, and S. L. Chappy, “The meaning of hope and social support in patients receiving chemotherapy,” Oncology Nursing Forum, vol. 35, no. 5, pp. 822–829, 2008.
[48]
M. S. Vos, H. Putter, H. C. van Houwelingen, and H. C. J. M. de Haes, “Denial in lung cancer patients: a longitudinal study,” Psycho-Oncology, vol. 17, no. 12, pp. 1163–1171, 2008.
[49]
M. S. Vos and J. C. J. M. de Haes, “Denial in cancer patients, an explorative review,” Psycho-Oncology, vol. 16, no. 1, pp. 12–25, 2007.
[50]
Y. S. Lincoln and E. G. Guba, Naturalistic Inquiry, Sage, Beverly Hills, Calif, USA, 1985.
