Gastrointestinal cancer has increasingly become a chronic disease due to the advances in medical care, which also imposed higher request on the self-care education to improve individual health conditions. According to the Orem’s self-care theory, the nursing knowledge is a foundation for chronic disease care, which greatly depends on the expertise of clinical nurses and varies individually owing to age, economic status, education status, hygiene conditions and intension. In this study, we performed a clinical investigation on the potential beneficial effects of the self-care education in gastrointestinal cancer patients. Our results demonstrated the severe side effects elicited by chemotherapy in the control group of gastrointestinal cancer patients during the intervention window, which included decreased role function, worsened nausea/vomiting, diarrhea and increased fatigue. The self-care education significantly improved the emotional function after 12-week of intervention in comparison with the control group, which highlighted its beneficial effect in mental stress relief in our gastrointestinal cancer subjects. The cancer-related fatigue frequently associated with physical, affective and cognitive factors. We further characterized the significantly worsened total fatigue in the control group despite the lack of remarkable changes in any of physical, affective or cognitive fatigue. The self-care education intervention greatly improved both affective and total fatigue, and the latter effect could be predominantly attributed to the former. We have also taken the depression status into consideration with respect to the fatigue reaction, and our finding highlighted that the self-care education intervention ameliorated total fatigue post-intervention in the subgroup with baseline depression in comparison with the subgroup without baseline depression. Taken together, our experimental investigation demonstrated the beneficial effects of the self-care education in gastrointestinal cancer patients under chemotherapy.
According to Orem’s self-care theory, the self-care education course consists of muscular progressive relaxation, distraction and nutrition optimization [11]. Muscle relaxation was especially effective in improving both pharmacologic and psychological nausea/vomiting complications associated with chemotherapy in cancer patients [14,15,16]. In agreement with this notion, in this study, our experimental subjects were instructed to relax muscles with a deep breath and finger massage, which showed evident benefits against nausea/vomiting and fatigue during chemotherapy.
Distraction was another well-accepted measure to relieve the severe side effects of chemotherapy [17,18,19]. Here we composed our self-care education course with music appreciation and meditation to distract the mind in the experimental patients before, during and after receiving chemotherapy. The patients who practiced distraction stayed calm, positive and improved physical function. Our results provided evidences in support of the beneficial effects of distraction against the side effects related to chemotherapy in gastrointestinal cancer patients.
Increasing data have implied that nutrition adjustment is the third way to control the severe side effects of chemotherapy in our self-care education intervention. In our design, patients participating the self-care education were instructed to switch their regular diet into dry, carbohydrate-rich, protein-rich and vitamin-rich foods, which was widely accepted for chronic disease patients as well [20]. Our results unambiguously demonstrated that persistent dietary adjustment significantly improved the quality of life of the experimental subjects in our questionnaire. Noteworthily, our subject patients were asked to keep continuous use of ginger before, during and after receiving chemotherapy. Ginger was widely used in Chinese food as an important spice and was also a multiple facet ingredient in traditional Chinese medicine in the treatment of nausea complications [21, 22]. Consistent with the previous report by Ghanbari et al. [23], our investigation based on the participant’s experience suggested the possible benefits of ginger in control of nausea/vomiting in gastrointestinal cancer patients under chemotherapy.
In summary, our data underlined the necessity of the self-care education for gastrointestinal cancer patients receiving chemotherapy. Notably, the current sample size was relatively limited and a large-scale population is warranted in the following investigations, wherein the confounding factors such as disease stage and therapeutic regimens potentially influencing the analytical results should be strictly controlled. The patients at different stages of the disease might benefit from the self-care education to varying degrees. In addition, certain variables were beyond the scope of this investigation including financial condition, mental and spiritual belief, as well as different interests and motivation levels of the participants.