Care and mobility considerations
The design of stomas has improved dramatically in recent years, as have the appliances to go with them. Problems of smell and leak are much less common. It would be extremely unusual for a stoma to be fashioned if the patient couldn’t physically take care of it themselves. If needs are claimed in relation to stoma care because of other disabilities supporting medical evidence of disability should be obtained.
Typically people with bowel cancer are able to attend to their care needs and have no difficulty getting around.
However problems with care and mobility are likely to arise when someone-:
- Has metastasis or recurrent disease
- Already has or develops other disabilities which compound the effects of bowel cancer or its treatment
Help with personal care for the purposes of DLA is typically not required during or after potentially curative treatment of colorectal cancer. Help with personal care will be required in the first few days after surgery. If a stoma is fashioned as part of the surgery help may be required for some weeks until the person gets used to managing it for them selves. A stoma care nurse will normally provide specialist support at home (visits and phone calls) for the first few weeks and be available in future should problems develop.
Care will not be required for the majority of the time during chemotherapy although during treatment weeks another person will probably need to help out with cooking, shopping and other tasks because of treatment side effects.
The exception to this may be people having very intensive treatment for rectal cancer. It can be appreciated that people having preoperative radiotherapy to the pelvis for up to 6 weeks followed by major surgery and possibly a 6-9 month course of chemotherapy after surgery are likely to have a prolonged period of fatigue and general debility. If severely affected by fatigue in the early period of treatment this is only likely to get worse and care needs may be identified.
If severe fatigue is present, it is likely that tasks can be physically completed but that any task requiring concentration or effort over a period of more than a few minutes will lead to extreme exhaustion and the need for rest and recovery.
Tasks such as dressing and preparing food are likely to fall into this category if they take more than a few minutes. Fatigue is particularly likely to affect ability to prepare food when exacerbated by problems such as mouth ulceration, nausea or loss of appetite related to treatment. There may be no motivation to prepare food in these circumstances and care in the form of encouragement to eat and drink as well as food preparation may be required.
Walking distance and exercise tolerance are likely to be reduced compared to normal, but stamina to walk for a few minutes e.g. 100 m from a hospital car park to a hospital ward or clinic will be maintained. There would normally be no need for physical support and no guidance or supervision needs would be present.
Amended April 2009
