Bowel Cancer Part 2 – The Latest Research and Strategies for Case Managers

From Specialised Health’s Exercise Physiologist, Ms Jennifer Smallridge:

In our previous email, we gave a comprehensive background of bowel and colorectal cancer, in light of the Decembeard initiative by Bowel Cancer Australia. In this update, you will find out why a multidisciplinary approach to bowel cancer works, and how best to provide support from a case management perspective.

Cancer survivorship essentials

The Department of Health and Human Services3 has compiled an optimal care pathway for people with colorectal cancer, and has identified four crucial components of survivorship care:

  • The prevention of recurrent and new cancers
  • Surveillance for cancer spread, screening for medical and psychosocial factors
  • Management of symptoms, distress and practical issues
  • Coordination of care between all providers to ensure the individual’s needs are being met.

Case management and appropriate referrals to allied health support can be particularly effective in managing the latter two stages of the pathway, and should not be underestimated in making the much-needed transition from treatment to remission, and ultimately returning to normal life.

Looking at the whole picture

Bowel cancer survivors may particularly need assistance with and consideration of the following:

  • malnutrition post-treatment due to ongoing treatment side effects (such as weight loss or reduced food intake)
  • altered bowel function and incontinence
  • stoma management
  • decline in mobility and functional status as a result of treatment
  • cognitive changes (altered memory, attention and concentration)
  • emotional distress, fear of disease recurrence, body image issues
  • a need for increased community support

The role of resistant starch

As nutrition is such a significant risk factor for bowel cancer in the first place, it can also assist or detract from appropriate recovery. Recent research2 has looked closely at the role of resistant starches in not only cancer, but type 2 diabetes and obesity. Resistant starch refers to the components of our dietary carbohydrates which pass through the digestive tract unchanged. It helps to feed the good bacteria in the intestine, and prevents the build-up of polyamines (cancer promoting chemicals) in the bowel2.

Resistant starch can be increased in the diet through consumption of the following foods:

  • Slightly green bananas
  • Potatoes and rice that has been cooked, and then cooled (eg: in salads)
  • Wholegrains
  • Seeds and beans such as chickpeas and lentils

Exercising beyond bowel cancer

The links between exercise and quality of life in cancer survivors has been extensively studied, however of interest to a particular group of researchers4 was the finding that as cardiovascular fitness went up, anxiety decreased and functional capacity increased.

Individuals who were previously active but failed to recommence exercise after cancer experienced the lowest quality of life in the following four years4, emphasising that exercise is helpful beyond just the physical benefits for this population group.

From a behaviour change perspective, exercise adherence is found to be highest5 when perceived behavioural control is also high (for example, when individuals feel confident in overcoming barriers and identifying enablers). This research further highlights the need for additional health behaviour support during this challenging time, something exercise physiologists are extensively trained in.

The most frequently reported6 barriers to exercise by bowel cancer survivors include:

  • Lack of time
  • Treatment side effects
  • Fatigue
  • Nausea/gastrointestinal upset
  • Surgical complications

Engaging in a well thought out work conditioning program is therefore a viable option and empowers the individual to make behaviour change to support their recovery.

The take home message:

The life insurance sector is well placed to support an individual across all stages of bowel cancer care, bridging the gap between initial diagnosis/treatment, to successfully returning to work and activities of daily living.

Making the right referrals at the right time supports the multidisciplinary recommendations of the research in this field and also facilitates the individual to move towards self-determination.



  1. Higgins, J. A., & Brown, I. L. (2013). Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Current opinion in gastroenterology29(2), 190-194.
  2. Gamet L, et al., (1992). Effects of short-chain fatty acids on growth and differentiation of the human colon-cancer cell line HT29. International Journal of Cancer, 52:2; 286-289.
  3. Department of Health & Human Services, (2015). Optimal Care Pathway for People with Colorectal Cancer, Victoria State Government.
  4. Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L. A., Jones, L. W., & Fairey, A. S. (2003). A randomized trial of exercise and quality of life in colorectal cancer survivors. European journal of cancer care12(4), 347-357.
  5. Courneya, K. S., & Friedenreich, C. M. (1997). Determinants of exercise during colorectal cancer treatment: an application of the theory of planned behavior. In Oncology nursing forum(Vol. 24, No. 10, pp. 1715-1723).
  6. Courneya, K. S., Friedenreich, C. M., Quinney, H. A., Fields, A. L., Jones, L. W., Vallance, J. K., & Fairey, A. S. (2005). A longitudinal study of exercise barriers in colorectal cancer survivors participating in a randomized controlled trial. Annals of Behavioral Medicine29(2), 147-153.