Last update: May 2017

Quebec launched a cancer control program (Programme de lutte contre le cancer) in 1998 following an extensive public and professional consultation. As a result, three types of oncology teams were gradually established across the province:

Local teams

Provide follow-up and support to people with cancer and deliver treatments, including chemotherapy, support care and end-of-life care.

Regional teams

Expert teams that serve as a point of reference for local teams. They have decision-making power over treatment, unless more specialized care is required. They are specialized experts on tumour sites and questions regarding patient support or palliative care.

Supra-regional teams

Ultra-specialized teams that act as a consulting body for regional and local teams. They decide on treatments and deliver care in complex cases requiring the use of leading-edge, experimental or intensive protocols. The members of supra-regional teams are each specialized in different types of cancer.

Whether you are under the care of a local, regional or supra-regional team, you will always have access to the latest diagnostic methods and most efficient treatments available which are tailored to your needs. To that end, cancer expertise is delivered by interdisciplinary teams made up of professionals from various disciplines working together toward a common goal of providing the right care at the right time to the right person.
 

Cancer is a complex health problem that requires the expertise of many healthcare professionals from various disciplines working together in partnership. Oncology teams – be they local, regional or supra-regional – call upon these professionals based on their needs and the types of cancer being treated. They have both similarities and differences. Here are descriptions of the roles of some of the professionals you may encounter during your cancer care journey.
 
Other hospital or community professionals:
 
Professional Role
Medical Oncologist or Hemato-Oncologist  Doctor specialized in cancer treatment, more specifically chemotherapy.
Surgical Oncologist  Medical specialist who performs surgery to diagnose cancer, remove tumours or repair damage.
Radiation Oncologist Doctor specialized in the use of radiation therapy to treat cancer.
Oncology Pivot Nurse  Resource person for patients and their family throughout the course of the disease. Evaluates their needs, provides support, gives information and participates in the coordination of care.  
Oncology Pharmacist  Pharmacist who prepares chemotherapy. Provides information on the treatment, its potential side effects and ways to alleviate them.
Nutritionist/Dietician  Professional who evaluates a person’s nutritional status and creates a tailored nutrition plan. 
Social Worker  Professional who evaluates social functioning. Provides support and psychosocial treatment services. Identifies available community resources and refers people to them.
Psychologist or
Psycho-oncologist
Professional who conducts evaluations and provides psychological counselling tailored to the needs of patients. Helps people adapt to illness and maintain their quality of life.  
Rehabilitation Specialists (Physiotherapists, occupational therapists, speech therapists, etc.)  Professionals who conduct evaluations and recommend treatments adapted to different patient needs. Develop and implement personalized rehabilitation programs.  
Gynecologic Oncologist
 
Obstetrician gynecologist who specializes in the treatment of gynecological cancers, who performs surgical operations to diagnose cancer, remove a tumor and gives treatments with chemotherapy.
Spiritual Care Professionals  Professionals who evaluate spiritual and religious needs. They accompany people in their search for meaning and provide moral support to loved ones.  

Other hospital or community professionals:
  • Family doctor
  • Chemotherapy clinic nurse
  • Liaison nurse
  • Research nurse
  • Radiation oncology technician  
  • Medical specialist
  • Dentist
  • Sex therapist
  • Community pharmacist
  • CLSC nurse
  • Community organizations
  • Etc.
The best way to reach your oncology team is to contact the oncology pivot nurse (OPN). OPNs play a central role in the care team. During your first meeting with your OPN, she will give you her contact information. 

Not everyone with cancer has access to an oncology pivot nurse.  If you need to reach your oncologist, ask to speak to his or her secretary. Your message will be passed on to your oncologist, along with your file to make sure he or she has all the information needed for your phone call. You can also ask your oncologist directly how to get in touch if a problem arises.

Many professionals of the oncology team hand out their contact information so patients can get in touch with them if needed. Carefully store all this information in a single place (e.g. your Oncology Passport).
An Oncology Passport is a special health booklet for people with cancer. It is a great tool to help you understand your treatment program, follow its course and actively participate in it. It is also your “calling card” if you ever need to go to the emergency room, since it will inform healthcare personnel that you are undergoing active cancer treatment (hence its name “Oncology Passport”).

The document contains many helpful sections, including:
  • A listing of useful information, such as emergency telephone numbers.
  • Information on symptoms that need immediate assistance and a special chart to help you better track and manage your side effects.
  • Spaces reserved to record your appointments, healthcare professionals, prescription drugs and overall state of health. 
The Oncology Passport is designed to foster a sense of partnership between people with cancer and healthcare professionals and to promote better disease self-management

Publication du MSSS (2008), Oncology Passport
Order online if the document was not submitted by a member of the oncology team
The Direction de la lutte contre le cancer (2011) defines the oncology care continuum as being made up of four periods: investigation, diagnosis, treatment and follow-up.
 
The investigation period involves the onset of cancer symptoms and the wait for screening and investigation test results.

The diagnosis period is the announcement of the cancer diagnosis and the wait for treatments.   

The treatment period corresponds to the start of treatments or their modification if the cancer returns.   

Finally, the follow-up period signals the end of treatments and the transition to survivorship, when medical follow-up and monitoring tests will need to be performed.

Two more periods – palliative care and end-of-life care – may also be added.   

Diagram: The Oncology Care Continuum

Source: Lise Fillion, R.N., Ph.D., Chantal Vézina, M.Ps. U.L.
 
Cancer treatment plans are based on the unique situation of each person with cancer. Your oncologist, in partnership with your care team, will continue to adapt it to your situation, based on your disease and health.

Treatment plans are made according to established recommended best practices in keeping with the most up-to-date scientific knowledge. They are based on internationally recognized medical practice guidelines.

Cancer Therapy Committee

Oncology teams discuss and make decisions on treatment plans as an interdisciplinary committee. The ultimate goal of these meetings is to determine the best possible treatment for each person with cancer.

The suggested course of treatment is then discussed with the patient. During this consultation, the oncologist provides information on the characteristics of the cancer, recommended treatments, expected benefits and potential side effects.

It is best for patients to be accompanied by a loved one for this consultation. It is important for patients to take the time to ask any questions they have and make sure they understand what is at stake, so that they make an informed decision about their treatment. Sometimes, people will need time to think before making a decision. Do not hesitate to ask about this.

Therapeutic Options

In some cases, there may be more than one therapeutic option available. This means that two or three different treatments have been recognized as equally efficient. It is then up to patients to decide on the most suitable treatment for them.

Clinical Trials

In other cases, the oncologist may propose a clinical trial.

The purpose of clinical trials is to evaluate new cancer treatments. In other words, before introducing new treatments to all patients, they need to be tested for efficiency and tolerability. It is not always possible to participate in a clinical trial, since specific criteria have to be met in order to be eligible.    

Participation is free and voluntary. Even before agreeing to take part in a clinical trial, you are free to leave at any time. Your oncologist will then recommend another treatment avenue. This decision will in no way affect the medical team’s commitment to treating you.

Single-drug or combination treatments

Some cancer cases require a single treatment drug. In other cases, a combination of drugs can be used to better control and treat the disease.

When more than one drug is used, they can be administered together or at different times, depending on the type and stage of cancer.

Curative Treatment or Palliative Care

Curative treatment includes all treatments administered for the purpose of curing a disease or bringing about prolonged remission.

“Curative treatments seek to cure people of disease, which may or may not be life threatening, by using all reasonable diagnostic and therapeutic means available. They also aim to preserve the quality of life of patients and their loved ones by preventing and treating the consequences of the disease and its related suffering without undermining the possibility of a cure.”  (Translation from CA GRASSPHO NOV 05) 

According to the World Health Organization (WHO) (2002):

“Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness: through the prevention and relief of suffering by means of early identification and impeccable assessment; and the treatment of pain and other problems – physical, psychosocial and spiritual.” 

Receiving a cancer diagnosis is extremely difficult and it is perfectly normal for people to want to act fast when they receive the news. Having to wait for services, test results and the start of treatments can be very stressful.

The ministère de la Santé et des Services sociaux du Québec (MSSS) has made timely access to care and services one of its policy priorities.
 
In its 2016-2017 Action Plan, the Direction générale de cancérologie states that:

“Access to medical services within a reasonable time frame is essential to ensure the health, quality of life and survival of people with cancer. The cancer care and service continuum must be organized in a way that promotes better access to screening tests, investigations, diagnoses and curative or palliative treatments.” 

To learn more about the objectives and actions taken to improve accessibility to cancer care and services, consult the Plan d'action en cancérologie 2016-2017 (in French only).

​References:

Canadian Cancer Society
 
Health Sciences North, Sudbury, Regional Cancer Program
 
Institut national du cancer, France

Hébert J. (2014) Plan de soins de suivi lors de la transition de la fin du traitement vers la survie au cancer: Où en sommes-nous? 

Gouvernement du Québec (2013) Plan directeur en oncologie 

​Gouvernement du Québec (1997) Programme de lutte contre le cancer : Pour lutter efficacement contre le cancer, formons équipe
 
Gouvernement du Québec (2005) Direction de la lutte contre le cancer : les équipes interdisciplinaires en oncologie

Bilodeau. K. et al. (2015) Canadian Oncology Nursing Journal • Volume 25, Issue 1: The care continuum with interprofessional oncology teams: Perspectives of patients and family
 
Santé et services sociaux, Québec, Lutte contre le cancer
 
Canadian Cancer Society: Prognosis and survival

Publication du MSSS (2008), Oncology Passport
Order online if the document was not submitted by a member of the oncology team

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Surgical Oncology

Surgical oncology is the branch of surgery concerned with the diagnosis and treatment of cancer. It is the oldest form of cancer treatment.

Oncology surgery includes all the surgical procedures required by those suffering from cancer:
 
Investigation – making a medical assessment in situations in which cancer is suspected
Diagnosis – specifying the type of cancer (biopsy)
Stage – determining the stage of the disease
Treatment – curing or relieving the symptoms of cancer 

The surgical treatment of cancer is the result of a multidisciplinary approach: all the specialists involved in cancer diagnosis and treatment participate in choosing the best treatment.

Accordingly, oncology surgeons are part of a multidisciplinary team made up of several professionals. They are all required to have specialized training and expertise in oncology.

Since it is a “local” treatment, surgery can be used alone or in combination with other treatments such as radiotherapy or chemotherapy.

There are various types of oncology surgery depending on the objective of the procedure. They fall under the following categories:

Diagnostic surgery

The aim of diagnostic surgery is obtain material that will contribute to the diagnosis. The surgical procedure most often employed is the biopsy. A biopsy consists of taking a sample of cells or tissue and analyzing it under a microscope.

This analysis, called pathological analysis, is used to determine the presence of cancer cells. If such cells are found, the specialist then determines the type of tumour in question.

Prophylactic or preventive surgery

Prophylactic surgery is a surgery performed to prevent cancer. It involves removing an organ before cancer develops.

Preventive surgery is indicated for those who have diseases or genetic mutations that greatly increase the risk of developing cancer.

Curative surgery

The aim of curative surgery is to remove the entire tumour while respecting a safety margin. The safety margin is the area around the tumour. This will be analyzed to check for the absence or presence of cancer cells. The size of the safety margin may vary, depending on the type of cancer and the location of the tumour.

Lymph nodes in the vicinity of the tumour may also be removed in order to determine whether cancer cells are present or to prevent them from growing (lymph nodes are small organs that play a role in the immune system).

Curative surgery can be either radical or conservative:
  • It is said to be radical when the organ containing the tumour is removed in its entirety.
  • It is said to be conservative when the surgeon preserves the role of the organ or its appearance. In this case, the surgeon removes only part of the organ. Conservative surgery is not always possible, depending on various factors such as the stage of the tumour.
The goal of curative surgery is to find the right balance between effective local control of the disease (i.e. removing all the tissue affected by the tumour or cancer cells) and preserving quality of life.

Tumour reduction surgery or surgical cytoreduction

The purpose of this type of surgery is to reduce the size of a tumour when it cannot be removed completely:
  • The tumour is too big;
  • The tumour cannot be removed completely without damaging neighbouring organs. 
In such cases, as much of the cancerous tissue as possible is removed (surgical cytoreduction). Once this surgery has been performed, further treatment with radiotherapy and/or chemotherapy will be carried out. In certain types of cancer, tumour reduction can increase the effectiveness of chemotherapy and radiotherapy.

Reconstructive or restorative surgery

Some oncology surgeries can leave significant effects that affect quality of life. Reconstructive or restorative surgery is one way to address these long-term effects.

Reconstructive or restorative surgery has several objectives:
  • To restore organ function or physiological function;
  • Restore physical appearance;
  • Reduce the side effects of other treatments (e.g. after radiation therapy). 
Reconstruction may take place immediately after removal of the tumour or a few weeks to a few months later.

The timing of reconstructive or restorative surgery depends on a number of criteria, including:
  • The type of cancer;
  • Its extent;
  • Other prescribed treatments;
  • The patient's wishes. 

Palliative surgery

The aim of palliative surgery is to relieve symptoms and improve quality of life. Examples of situations in which palliative surgery may be indicated:
  • To reduce a tumour that has spread and is compressing (crushing) organs or tissues around it. This compression can be reduced by surgery.
  • To create a bypass (an artificial pathway) (e.g. in the airways to facilitate breathing or in the digestive tract to facilitate feeding).
  • To administer various palliative treatments via natural respiratory, digestive or urinary tracts.
  • To strengthen bone that has metastasized and become brittle in order to prevent fracture and relieve pain.
The use of this type of intervention sometimes arises in emergency situations. Decisions often have to be made quickly.

Surgery for secondary cancers or metastases

Surgery can be used to remove a metastasis. A metastasis is a secondary tumour that develops in another organ due to cancer cells originating in the primary tumour that have spread to other parts of the body.

Metastasic surgery is performed especially if:
  • There is only one metastasis or a small number of metastases;
  • The intervention can increase survival and sometimes bring about remission;
  • The patient’s general state of health permits the surgical intervention;
  • The cancer is "controlled locally," i.e. there is no recurrence or local spread. 

Surgery to support treatment

Surgery is sometimes used to support treatments or the functions of an organ affected by treatments. Here are some examples of supportive surgery:
  • Installation of a central venous catheter under the skin, a small device known as a Port-a-Cath. This allows the patient to receive chemotherapy, antibiotics, blood products or nutrients intravenously (I/V).
  • Installation of a gastronomy (feeding) tube in the stomach for those who can no longer eat or drink.
  • Installation of a tracheotomy (opening in the trachea) to allow the passage of air when there is an obstruction or risk of obstruction.

Sources

Types of surgery
 
Today, several surgical techniques are used. The surgeon's choice of technique depends on a number of criteria:
  • The type of cancer and its stage;
  • The location of the tumour;
  • The size of the tumour;
  • The purpose of the surgery;
  • The patient's general state of health and their wishes.
The most frequently used surgical techniques are the following:

Conventional open surgery

This is performed by way of an incision that may be dozens of centimetres in length. Procedures include laparotomy for an opening of the abdomen and thoracotomy for an opening of the thorax.

Endoscopic or minimally invasive surgery

This procedure uses small openings in conjunction with an endoscope, a fine instrument equipped with a camera that makes it possible to view the inside of the body on a screen. The endoscope is introduced into the body through natural channels (mouth or anus for the digestive tract for example) or through small incisions of about 1 cm.

Using small incisions, specialized surgical instruments are passed through tubes to reach the area to be operated on. Depending on the area of the body concerned, endoscopy takes different names:
  • Laparoscopy is performed via the abdominal cavity and permits visualization and intervention in the digestive, gynaecological and urological system;
  • Thoracoscopy permits visualization and intervention in the thorax.

Laser surgery

This form of surgery destroys cancer cells through the action of intense light delivered by a laser. In cancer treatment, laser surgery can be used to:
  • Destroy cancer cells;
  • Remove a tumour or abnormal tissue on or near the surface of an organ or skin;
  • Relieve symptoms caused by the tumour, such as bleeding, pain, shortness of breath or an obstruction.
Although laser surgery cannot be used to treat all types of cancer, it can be useful in the following cases:
  • Precancerous conditions of the cervix such as cervical intraepithelial neoplasia (CIN) and carcinoma in situ of the cervix;
  • Esophageal cancer;
  • Cancer of the vocal cords;
  • Lung cancer;
  • Precancerous conditions of the vagina or vulva;
  • Cancer of the penis;
  • Non-cancerous skin tumours.

Robotic surgery

In robotic surgery, also known as laparoscopic robot-assisted surgery or computer-assisted surgery (CAD), the surgeon sits at a station near the patient, who is lying on the operating table. The surgeon uses a computer to move robotic arms attached to surgical instruments inside the patient’s body.  Robots are able to perform very precise movements.
 

Sources (in French only)

Oncologie chirurgicale
Un traitement local
Quelques mots sur la chirurgie oncologique
Chirurgie : types et objectifs
Traitement chirurgical
The following is an overview of preparing for all types of surgery, oncological or otherwise. However, the procedures described may differ from one care setting to another. 

Types of anesthesia

Surgery can be performed in the doctor's office, on an outpatient basis in the hospital or in an operating room. It is performed under the following types of anesthesia:

1-Local

A type of temporary anesthesia that numbs a specific area of the body to ensure that the surgery does not cause pain. The principle is to temporarily block nerve conduction in a specific area to prevent painful sensations. Several samples or biopsies can be taken in this way.

 2-Locoregional

A type of anesthesia that consists in temporarily halting the transmission of nerve messages in a specific area of the body in order to permit surgery. It involves injecting local anesthetics in the vicinity of a nerve, a group of nerves or in the spine in order to numb a region of the body. The patient no longer feels anything in the targeted part of the body, yet remains conscious.

3-General

A type of anesthesia that brings about a state comparable to sleep. It is produced by injecting drugs into the bloodstream (intravenous infusion) or by inhalation of a gas. Under general anesthesia, the patient loses consciousness during surgery. He or she feels nothing and has no memory of the intervention. Awakening is gradual and usually peaceful.

The type of surgery performed, the type of anesthesia used and the overall health of the person determine the choice of same-day outpatient surgery or hospitalization. The latter may be very short, from 1 to 2 days, or longer, from 1 to 2 weeks or more.

The surgeon and the health care team provide information on the following topics:
  • What happens before surgery and how to prepare for it;
  • How the procedure is carried out and how long it is expected to take;
  • The type of anesthesia that will be used;
  • The possible after-effects of the intervention, the type of follow-up required, and the probable recovery time;
  • The main risks associated with the procedure.
The surgeon frequently requests various tests and examinations before surgery. These tests depend on the surgery to be performed, the person's state of health and their medical history. The anaesthetist may also request tests.
 

WARNING!

Whether the surgery is performed as outpatient surgery or with hospitalization, in order to prevent complications it is recommended that patients:
  • refrain from smoking (ideally 6 weeks before surgery): nicotine delays the healing process and increases the risk of lung infection;
  • reduce or cease alcohol consumption: some medications cause side effects when taken with alcohol;
  • stop using natural products 2 weeks before surgery. 

Hospitalization time

Same-day surgery

When outpatient surgery is to be performed, with the patient returning home the same evening, a telephone or face-to-face meeting is conducted with a nurse. The nurse gathers the relevant information from the file and gives the information and advice on the upcoming surgery and the postoperative period. She also ensures that everything is ready for the day the surgery is to take place. If examinations are required, they will be performed at this meeting or in the following days, depending on the date of surgery. Preoperative preparation instructions such as the required fasting period or taking medication will also be given. The patient may also be supplied with an educational guide on the surgery.

The day before the surgery (on Friday, if the surgery is scheduled for Monday), the person will be informed by telephone of the presumed time of surgery and the time at which he or she must report to the Day Surgery department. On the day of the surgery, the person will arrive at the appointed time and will generally have fasted (specific instructions to be followed). He or she must have followed the instructions for preparation such as showering or bathing, removing makeup and nail polish as well as taking medication, if prescribed. A nurse will ensure that the final preparations are complete before the surgery.

After surgery, the person will go back to the day surgery room for a day for a recovery period of variable length. A nurse will check vital signs on a regular basis in order to ensure good short-term recovery. The surgeon will often make a visit to give information about the surgery and will specify the instructions for convalescence and postoperative follow-up.

Upon returning home, the operated person must be accompanied and the accompanier or some other person must stay with the operated person until the next morning to ensure his or her safety.

Inpatient surgery

In general, the preoperative preparation for inpatient surgery is carried out in a preoperative care unit. A nurse will assemble the relevant information and provide information and advice on the upcoming surgery. Any necessary examinations and medical consultations with other specialists will also be performed during this preparatory day. Oral or written preoperative instructions and patient education guides on the surgery, if available, will be issued on this day. Sometimes the person may have to attend over a 2-day period if several examinations or consultations are required. The goal of this procedure is to have the ready person to undergo surgery in an optimal, safe manner.

The day before the surgery (on Friday, if the surgery is scheduled on Monday), the person will be informed by telephone of the presumed time of surgery and the time at which they have to report to the Ambulatory Preoperative Care Department.

On the morning of the surgery, the person must arrive at the scheduled time and will be taken care of by a nurse who will make the final preparations. They must have fasted (in accordance with specific instructions) and followed the instructions for preparation such as showering or bathing, removing makeup and nail polish, intestinal preparation if required, as well as taking any prescribed medication.

In preparation for hospitalization, the person must prepare a small suitcase, clearly identified with their name, for their personal belongings. The nursing staff will give instructions about the recommended items to bring.

The length of time spent in the operating facility before returning to the post-op room can vary greatly and is often far longer than the anticipated duration of the operation. In fact, to the time of the actual operation must be added the time needed to set up the anaesthesia, the time spent in the recovery room and the time required to get a bed ready to receive the person operated on, which is difficult to control.
 

WARNING!

Whether the surgery is performed as same-day surgery or with hospitalization, it is essential to inform the nursing staff in the preoperative units of any change in health status and any change in medication that occurs between the preparation day and the day of the operation.

Meeting with the surgeon after the operation

For family and friends, the time of the operation is a source of concern and many will want to receive news as soon as possible. Surgeons often meet with family and friends after surgery. In order to obtain a meeting with the surgeon, if possible, it is recommended that a request be made directly to the surgeon, who will explain the procedure and set an approximate time for a meeting after the surgery.


Sources (in French only)

Guide d'accompagnement et d'enseignement conçu pour les patients devant subir une chirurgie, CHU de Québec
L'anesthésie locale
L'anesthésie loco-régionale
Information médicale sur l'anesthesie

Postoperative care begins at the end of the operation and continues in the recovery room or day surgery room, as appropriate, throughout hospitalization and continues during the return home and recovery period.

The main goal of postoperative care is to help the person's body regain its equilibrium. Postoperative follow-up serves three purposes:
  • Ensuring personal safety and comfort upon return from the operating room;
  • Permitting optimal recovery and the greatest possible autonomy;
  • Preventing possible complications from the operation. 
Immediately after the operation, depending on the type of surgery, the medical team checks:
  • Respiratory, cardiac and renal functions (by regularly recording vital signs, oxygen saturation, urinary elimination and by observing and monitoring for signs of complications);
  • The wound, dressing, drains, intravenous infusions and any urinary catheters that may have been put in place;
  • The presence of pain and its intensity in order to relieve it effectively;
  • The patient’s mental and emotional state. 
Monitoring tests such as an electrocardiogram (ECG) or a blood test may be requested by the surgeon or a consulting physician depending on the individual's general condition and medical history.

Phlebitis, also known as deep vein thrombosis (DVT) (i.e. the formation of a clot in a vein), is monitored and prevented by administering preventive treatment to patients who are obliged to lie still for long periods of time.

Postoperative pain control

It is normal to experience pain after surgery. This is often worse in the first 24 to 48 hours and gradually diminishes afterwards. The health care team is there to help the person get the most effective relief.  The nurse will assess the pain throughout the hospital stay. The pain is rated on a scale from 0 to 10, with a value of "0" for no pain and "10" for the worst pain.
Example of a pain scale from 0 to 10:


 
It is important for the pain to be relieved. It helps the patient recover more quickly and prevents complications. Having less pain makes it easier to move, breathe, sleep and eat.

These are the types of medications that may be used for pain relief following surgery:

Patient-Controlled Analgesia (PCA)

Medication administered as needed using a pump connected to the intravenous infusion. When pain occurs, the patient presses a button on the controller connected to the pump. A small amount of medication is then injected. This pump is simple and safe to use. It is programmed not to exceed the dose prescribed by the doctor.

Epidural analgesia

Medication administered continuously through a catheter in the back close to the spine. As described in the previous paragrap, a lever connected to the pump that administers the medication can be used as needed for certain surgeries.

Subcutaneous analgesia

Medication administered by injection under the skin prescribed as needed at intervals determined by the physician. It is recommended that the patient ask the nurse for this medication as soon as the pain starts so that it does not become too severe and thus more difficult to relieve.

Oral analgesic tablets

This type of medicine, taken orally, should be administered as soon as possible. It should also be requested directly upon the onset of pain. This allows the health care team to make sure that the medication relieves the pain well before the patient returns home. When a patient leaves the hospital with medication for at-home pain relief, analgesic tablets are most often prescribed. Analgesic medication that is given postoperatively may cause side effects, including nausea and constipation.

To control nausea, the doctor will prescribe medication that will be administered by the nurse as needed, hence the importance of reporting this adverse reaction to the nurse.

In the event of constipation, here are a few guidelines, if so instructed by the doctor, easily applicable at home, to prevent and better manage it:
  • Drink plenty of water (6-8 glasses per day);
  • Eat fruits, vegetables and whole grain cereals;
  • Consume hot drinks: broth, soup, herbal tea, weak tea to help stimulate the intestines;
  • Eat meals and snacks at regular times;
  • Perform light exercise (walk after a meal).
The nursing staff will take appropriate steps in order to prevent post-operative complications.

Early mobilization

It is recommended that the patient move every 2 hours when lying down.
The first time the patient gets out of in bed, it should be with the help of the nursing staff, who will use a safe technique to help them get out of bed the first time. It is recommended that patients follow instructions carefully and avoid trying to get out of bed alone.

Breathing exercises

These help eliminate secretions after surgery and thus avoid pulmonary complications such as respiratory infection (pneumonia). It is recommended that these be performed 5 times an hour with or without a spirometer (a device that facilitates deeper breathing), using the following technique:
 
Without spirometer
In a seated or semi-seated position, place your hands on your stomach.
Breathe in slowly, inflating the belly and hold your breath for 3 seconds.
Exhale slowly through the mouth.
If breathing exercises cause pain due to a stomach wound: use a pillow or folded blanket to put pressure on the wound when exercising or coughing.

With spirometer
In a seated or semi-seated position, exhale to completely empty your lungs.
Place the mouthpiece of the device in your mouth.
Take a slow, deep breath to lift the ball in the device for about 3 seconds.

Circulatory exercises

Circulatory exercises help blood circulation and reduce the risk of blood clots in the veins (thrombophlebitis). It is recommended that they be performed several times an hour using the following technique:
  • Lying on your back, take a deep breath;
  • Point your toes as far as possible and then pull your feet vigorously towards your chin;
  • Breathe out slowly.

Resuming eating

Eating should be resumed as soon as possible yet gradually, depending on the type of surgery, while observing appropriate precautions.

Hygiene

If necessary, assistance will be provided for hygiene care until your gradual return to autonomy.

Urinary and intestinal elimination

For some surgeries, a urinary catheter (a flexible tube in the bladder for emptying urine) will be inserted postoperatively. This may be required from 24 hours to a few days. It allows the bladder to be emptied and kidney function to be monitored.

When eating is resumed gradually, gas may be produced. It is normal to have no bowel movements for the first few days.
 

WARNING!

It is important to tell the nurse if it is difficult or impossible to urinate and if any discomfort or constipation occurs.

Rehabilitation program

Some operations can cause temporary or permanent sequels or medical complications that require rehabilitation. Rehabilitation should be started as soon as possible after the operation by specialized professionals such as physiotherapists, occupational therapists, nutritionists or others.

Teaching self-care

Self-care is the care the person gives to themselves (for example, do-it-yourself actions to promote wound healing).
When necessary, the nurse will introduce a self-care education program as soon as the person's condition permits. This often involves learning how to care for wounds or drainage devices (drain, urinary catheter, ostomy care, etc.). The patient will put this knowledge to use upon their return home after hospitalization for a variable length of time, whether on a temporary or permanent basis. Depending on particular needs, some people may be referred to the CLSC in their region for specific care or supervision.

Returning home

Planning the return home

Planning for the return home begins as soon as the dates of the surgery and the expected recovery are known. These are a few recommendations to ensure you are well prepared:
  • Arrange things at home so as to make your convalescence as easy as possible. For example, facilitate movement by removing unnecessary furniture or objects. Install larger bedside tables near your bed and chair that can hold everything you need to be comfortable.
  • If possible, it is recommended that you prepare meals in advance and freeze them. They will be ready when you return home.
  • Make the necessary purchases at the grocery store and drugstore.
  • Make sure you have a supply of acetaminophen (Tylenol) for postoperative pain relief.
  • Make sure you have a thermometer at home to check your temperature when needed.
  • Consider calling on community support services such as: housekeeping, meals-on-wheels, etc. You can get information on these services by calling 211 in certain areas covered by the service or by consulting the "Community and Social Resources" section in the yellow pages of your telephone directory.
  • If the home help is insufficient or if the general condition of the patient so requires, you may be able to book a stay in a convalescent home: information is available in the "Retirement Homes for Seniors” section in the yellow pages of the telephone book or on the website of the Ministère de la Santé et des Services sociaux

Return home and convalescence

In the days or day before release from hospital, the nursing staff or the surgeon will advise you of the possible date of departure. As soon as your planned departure date is known, it is important to notify family and friends in order to plan the return home, accompaniment and transportation. One person will have to stay with you for the first 24 hours. It is the patients’ responsibility to organize their transportation with their loved ones. People who leave the hospital after surgery are generally able to take care of themselves on a daily basis. You may, however, need help with household activities such as cooking, cleaning or shopping.

Ideally, departure should take place early in the day—in the morning, if possible. Here are some important questions to clarify before you leave:
  • Previous medication: stop, resume or continue?
  • New medication: take for how long?
  • When to schedule your follow-up appointment with the surgeon?
  • Ask for a summary of the hospitalization to send to the family doctor.
  • When should you see your family doctor again?
  • Will you need prescriptions for specific medication, wound care or nursing intervention?
  • When should you take a shower? A bath?
  • When can you resume normal activities and sports?
  • When can you start driving again?
  • When can you go back to work?
Before leaving the hospital, make sure you have your health insurance and hospital cards to hand, as well as all necessary medical prescriptions and personal medication.

Healthcare personnel will provide clear written or verbal instructions. The information should be tailored to the individual and the clinical situation. Among other things, they will advise the patient or caregiver about the signs and symptoms they should look out for, if relevant, and to notify them accordingly. If there is a request for home care, a liaison nurse will inform the person of the planned follow-up and the date of the first home care visit by the home care nurse.

Pain relief at home

The health care team will provide instructions on the use of analgesics and will issue a prescription if necessary. It is important to relieve pain. The pain will gradually subside, and the analgesic medication will also be reduced until the pain stops. As soon as the pain is less severe, take acetaminophen (Tylenol) rather than another analgesic for as long as it is effective. Follow the prescribed or recommended dosage carefully.

Wound and dressing

For wound and dressing care or postoperative recovery exercises, you should follow the surgical educational guide or the instructions specified by the nursing staff. If more complicated care is required, a request may be made to the CLSC. Nursing staff will travel to the home for people with reduced autonomy, but those who can travel will be attended to by appointment at the CLSC offices.

The surgical wound should be kept out of the sun for a period of 12 months.

Hygiene

Follow the surgeon's instructions and the educational guide. Avoid getting the wound wet until it is completely closed. Make sure you are familiar with specific instructions for showering or bathing.

Physical activity

Follow the surgeon's instructions and the educational guide. Avoid strenuous physical effort and activities. Physical activity is essential for recovery and renewal of energy, but must be resumed gradually in order to maintain a balance between activity and the rest required for convalescence. Avoid overexertion by having several short periods of activity rater than one long one. Consult our kinesiologists as needed.

Back to work

The doctor will determine when you can start work again. If you have to stop work during your convalescence, provide the insurance documents required by the employer so that they can be completed by the surgeon. When you are fit to return to work, you are advised to take advantage of gradual return-to-work programs if these are available at your workplace. At the appropriate time, it will be up to the surgeon to specify the terms for a progressive return to work.

Complications to watch out for

Call Info-Santé (dial 811), the oncology pivot nurse (if applicable), the Info-cancer Hotline (at 1 800 363-0063) or go to the emergency room if one or more of the following symptoms occur:
  • Pain that increases even with medication;
  • Signs of wound infection such as: increasing redness, swelling, pus discharge, pain, heat;
  • Fever: Oral temperature for adults under 65 years of age = 38.5°C (101.3°F) and above; for adults 65 years of age and over = 37.8°C (98.6°F) and above;
  • A lot of blood on the dressings;
  • Inability to eat or drink;
  • Vomiting;
  • Burning sensation when urinating;
  • Difficulty or inability to urinate;
  • Constipation unresolved after following instructions issued by personnel upon departure;
  • Swelling or pain in a calf that increases with walking;
  • Shortness of breath (dyspnea);
  • Chest pain;
  • Other signs and symptoms listed in the surgery-specific educational guide. 
In case of emergency, call 911.

Duration of convalescence

Convalescence is the time after the operation during which recovery is achieved, with a gradual return to health. Its duration varies greatly, from a few weeks to a few months. It varies according to the age and overall health of the person, the type of surgery performed, the rehabilitation required and the type of anesthesia used. However, regardless of the type of surgery performed, it is normal to feel tired. The body mobilizes resources to work on healing and this requires a lot of energy. It is therefore necessary to rest and gradually resume activities in accordance with the energy available. If you are concerned about prolonged fatigue, it is recommended that you inform your health care team or contact the oncology pivot nurse (if necessary) or the nurses at the Info-cancer Hotline at 1 800 363-0063.
 

Sources (in French only)

Le congé et le suivi en période postopératoire
Suivi post-opératoire
Soins post-opératoires
Surveillance post-opératoire
Les exercices respiratoires après une opération
Spirométrie incitative


Sources
Surgery in cancer treatment
Cancer Surgery
Surgery to Treat Cancer

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