What do pharmacists need to know about bowel cancer?


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07 May 2018

Pharmacists are well placed to advise patients on what to avoid to prevent this common cancer, writes Sophia Lowes

KEY LEARNING POINTS

  • More than half of cases of bowel cancer in the UK could be prevented
  • Pharmacists can identify potential sufferers of bowel cancer by keeping track of customers’ repeat purchases
  • Pharmacists are ideally placed to speak to patients confidentially about any symptoms they may be concerned about

 

What is bowel cancer?

Bowel cancer, also known as colorectal cancer, starts in the colon (large bowel) or back passage (rectum). It’s the fourth most common cancer with around 42,000 cases diagnosed every year in the UK.

But more than half of these cases could be prevented. And not only that, but diagnosing bowel cancer early makes a huge difference too. When it is caught at the earliest stage, more than 9 in 10 people will survive their disease for 10 years or more.

Pharmacists can play a key role in helping people to reduce their risk of bowel cancer, raising awareness of bowel screening and encouraging customers to seek further help when necessary.

 

What causes bowel cancer?

As with most cancers, the risk of bowel cancer increases with age. Most cases are in people over 50. A family history of bowel cancer, or other bowel conditions, such Crohn’s disease, can also increase a person’s risk.

But there are proven steps everyone can take to reduce their risk of bowel cancer. And they can help to reduce the risk of other diseases too. Take a look at our top tips to share with your customers:

  • Go smoke free. Smoking increases the risk of bowel cancer. Your pharmacy might offer smoking cessation services, or you can refer individuals to local, free Stop Smoking Services, where smokers are roughly three times more likely to quit successfully compared to going cold turkey.
  • Keep a healthy weight. Weight can have a big impact on the risk of cancer. It can be hard to stay a healthy weight but reassure your customers that small changes to diet and activity can all add up. Making changes they can stick to in the long term is key.
  • Eat more fibre. Having more fibre cuts the risk of bowel cancer. Why not suggest swapping to wholegrain versions of bread, rice and pasta as an easy way to increase fibre intake?
  • Eat less red and processed meat. Eating a lot of processed and red meat can increase the risk of bowel cancer. Opting for chicken, fish or high-protein foods like pulses instead can be a simple way to cut down. Customers don’t need to give up meat completely, but just cut back where they can.
  • Be active. You can reassure customers that exercise doesn’t have to be running a marathon. It’s anything that gets you a little hot and out of breath. It can include brisk walking, gardening or playing games with children.
  • Cut back on alcohol. The less you drink, the lower the risk of cancer. You could suggest people try having more alcohol-free days each week, or swapping every other alcoholic-drink for a soft-version.

 

What should I be looking out for?

If customers report any of the following, you should encourage them to talk to their doctor:

  • A persistent change in their normal bowel habits, such as looser stools, more frequent bowel movements and or/constipation
  • Bleeding from the bottom or blood in stools. This can look red, or it can be black and make the stools look dark, like tar.
  • Stomach pain (especially persistent pain) or a lump in their stomach
  • Unexplained weight loss

You should also encourage your customers to get to know what’s normal for them, including their bowel movements. That way they’ll be more likely to notice changes. And if they do notice any unusual or lasting changes, they should speak to their doctor.

And even if a change isn’t on the list above, when a customer asks for advice about a change they’re worried about, make sure they talk to their doctor. In most cases it won’t be cancer, but it’s best to get it checked out.

You’re also in a great position to be able to notice if customers are repeatedly buying medications to treat the same symptom – and act as the nudge they need to see their doctor about it. Just asking what their doctor said about it can be a great way to start a conversation and find out more.

 

Screening for Bowel Cancer

Even if a customer hasn’t asked you specifically about bowel cancer symptoms, there may still be an opportunity to signpost them to the UK’s bowel cancer screening programme.

Screening is for healthy people without symptoms. People aged 60-74 who are registered with a doctor are automatically invited to complete a home test every two years in England, Wales and Northern Ireland. In Scotland, the age range is 50-74 years.

Invitations and screening tests are sent in the post. You can encourage customers to register with their local GP to make sure they receive an invitation. They should read the information with the test to decide whether they’d like to take part. You can also offer support and tips on how to use the screening test kit for customers with questions; a fact sheet to talk through with customers can be found.

 

Talking About Bowel Cancer

Many people find it difficult to make the most of their GP appointment, so pharmacists have an important role in supporting patients. You can begin a conversation about symptoms and encourage return visits if the problem doesn’t go away.

It’s important that people don’t just dismiss changes as ‘part of getting older’ or assume they are down to another health condition. If a customer keeps returning to the pharmacy for the same problem, make sure they see their doctor. Reassure them that they should be as stubborn as their symptom – and not worry that they are wasting your or the doctor’s time. You could help them work out how to describe the changes and how long they’ve had them for, so they can be prepared for their appointment.

Visual resources can be useful for raising awareness and prompting conversations. For example, a display showing the bowel screening kit, or offering customers a leaflet along with their medication. Cancer Research UK has lots of resources available for pharmacies to display or hand out – you can order them for free from www.cruk.org/publications.

Cancer Research UK also has nurse-led workshops and online training to help you feel more confident talking about ways to reduce the risk of cancer and the importance of spotting it early with your customers. You can find out more at cruk.org/talkcancer.

A positive way to address the sensitive topic of cancer is to encourage people to ‘take charge’ of their health, empowering them to seek help and advice if needed. While some symptoms can be tricky to discuss, there’s nothing to be embarrassed about: we’re all human!

Sophia Lowes is Cancer Research UK’s health information officer

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