by Vera Martinella
It is crucial to go to specialized centers to have a better chance of healing and to have a team of multidisciplinary experts to live longer and better
Living without a stomach is possible, but complicated. The good news for many people who discover they have gastric cancer and have to face the complete removal of this organ so important that thanks to the arrival of new treatments the survival of the sick is lengthened and today over 82 thousand Italians live after the diagnosis. The bad news is that the cases, which had been decreasing for years, have also started to grow again in our country and in 2022 about 14 thousand were registered. It is certain that stomach cancer is a disease which, more than others, changes life: returning to life by recovering a stable psychophysical balance is not a simple matter. Yet it is possible, as demonstrated by the stories told to Corriere by Claudia, operated on in 2008, and Maria, who in 2015 underwent preventive removal of her entire stomach after discovering that she was the bearer of a genetic mutation that exposed her to the great danger of to get sick.
specialized centres
Undergoing a stomach resection involves numerous adaptations, physical and psychological: accepting the lack of an organ, living with the many problems that follow – recalls Claudia Santangelo, president of theassociation You can live without a stomach which he founded 10 years ago to help other patients with the same difficulties as himself -. It is necessary to manage the fear of relapses and therefore of dying, being able to accept the different perception of one’s body linked to malnutrition and weight loss, a very frequent phenomenon among gastroresected patients. Psychosocial assistance, aimed at all those aspects that do not concern the treatment of cancer in the strict sense (such as psychological disorders and socio-relational difficulties) is crucial for a better life. If patients today live even many years after treatment, they must be able to do it in the best possible way. The needs of the sick were at the center of a recent meeting organized in Rome by the association, during which the fundamental importance of being treated in a specialized center was recalled, where the various doctors discuss each other in order to choose the therapies more indicated in the individual case, because in this way the chances of surviving and living better increase.
Psychological support
In this seminar we wanted to address various aspects of the new post-gastrectomy life with the hope that in the treatment centers the figure of the psycho-oncologist will be foreseen within the multidisciplinary units – adds Claudia Santangelo -. In Italy there are only three PDTAs (the diagnostic therapeutic assistance pathways: that is, in practice, what would be needed for a patient, wherever he lives in the country, to be able to access the best trained specialists in this form of cancer and the most effective therapies without wasting precious time) regional to the stomach. All this labels us as second-class citizens. Psychological support is now considered an active and integral part of the same medical oncology by the scientific community. It’s time to adjust to the change. Gastroresected patients are among the most complex, both for the diagnosis, which usually arrives late, and for the consequences of the surgery and pre- and post-surgery therapies, which can be heavy.
Symptoms
Unfortunately, gastric cancer is in many cases diagnosed in an advanced stage, so only 40% of patients are able to undergo radical surgery and have hope of recovery. It is in fact one of the most aggressive neoplasms with a particularly difficult prognosis (only a third of patients alive five years after diagnosis), a high recurrence rate and characterized by the presence of late symptoms. You have to pay attention to a series of signs that may be non-specific or indicative of minor problems, but it is better to speak to a doctor in case of: persistent digestive disorders, loss of appetite, difficulty swallowing, weight loss, feeling of fullness after meals, nausea and vomiting, heartburn (burning behind the breastbone), bloody or black stools, chronic tiredness. Those most at risk of getting sick must not ignore these alarm bells: people who suffer from atrophic gastritis (an inflammation of the stomach) or from a chronic infection caused by Helicobacter pylori, responsible for ulcers and gastritis . However, the last decade has recorded an improvement in therapeutic strategies in both operable and advanced disease.
Living without a stomach
However, those who survive have to deal with continuous checks and need help. The concept of rehabilitation is fundamental as well as psychological support, the correct indications during and after the therapies in terms of food, behavior and sexuality. What happens to those who live without a stomach? First of all, completely change your relationship with food: the first thing to learn is not to eat and drink at the same time, it is essential to rely on a nutritionist expert in gastrectomized patients. Great care must be taken in choosing what to eat: unfortunately, over the years, glycemic swings (which can cause significant damage) and excessive weight loss become more and more frequent: as gastrectomised patients, one generally suffers from malnutrition and for all life vitamin B12 will be lacking, as well as often iron, folin and vitamin D (for which specific supplements are prescribed), useful against osteoporosis. All of this implies, over the years, other problems: the skin suffers, hair and teeth weaken, the bones become more fragile, one suffers from constant fatigue, often from tachycardia. After eating, then, you may have palpitations, fainting, breathlessness and it is essential to take moments of rest throughout the day (especially after lunch to manage and overcome glycemic swings).
The need for information
The patient with gastric cancer is often confronted with a very complicated situation: all possible help is needed on a psychophysical level, for nutrition and depression, for the economic problems triggered by the disease itself and for work, relational and sexual problems – underlines Rodolfo Passalacqua, oncologist at the Cremona hospital and coordinator of the guidelines of the Italian Association of Medical Oncology (Aiom) for the psychosocial assistance of cancer patients -. It is not necessary to cure the tumor, but at the same time to activate a set of structured interventions, with trained personnel, to respond to the set of new needs. International studies show that the main needs of patients are information and knowledge about the disease, its consequences and what awaits the patient once he returns home. All these aspects cannot be tackled randomly but through structured interventions and specialized personnel. Gastroresected patients ask for answers to their needs, not only those related to disease control, they want to achieve overall well-being, they think about their quality of life. It is important to ensure a care response that addresses many different needs.
Sexuality, weight loss, tiredness
There are only a few Italian oncological realities that follow and implement this approach, which is also recognized as very valid. An international study has demonstrated a prevalence of sexual disorders in 40% of gastroresected patients, 47% ask for help to overcome the problems of the intimate sphere and this need for psychological support is also present in the advanced stage of the disease. Chemotherapy leads 32% of patients to interrupt their sexual life and 41% to decrease the frequency of intercourse. Not offering a global assistance response means not giving the patient the opportunity to project himself back into the future once the experience of illness has passed – concludes Patrizia Pugliese, psycho-oncologist and SIPO Lazio coordinator -: among gastroresected patients over 45% suffer changes in the sphere sex and more than a third ask for assistance. Unfortunately, this question does not correspond to an adequate answer. The gastroresected patient loses weight and has serious problems of malnutrition, which involves a change in body image, fatigue (or chronic tiredness) which leads to alterations in everyday life in every aspect. Male impotence and female dyspareunia are the most common problems. Of course, the sentimental component revolves around the physical dysfunction, of pleasure, eroticism, desire, elements that decay. The couple’s relationship is affected by a refusal of the sexual reprise by the patient who projects his distorted body image onto the other. At this point, an integrated intervention between various specialists is necessary, obviously including the psycho-oncologist.
July 5, 2023 (change July 5, 2023 | 08:49)
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