Body image mediates the effect of stoma status on psychological distress and quality of life in patients with colorectal cancer

Abstract

Objective:We investigated the effect of stoma status (permanent stoma, temporary stoma, or non-stoma) on psychological distress and quality of life (QOL) in Chinese patients with colorectal cancer (CRC) in the early postoperative stage. We also investigated whether body image mediated the association between stoma status and psychological distress and QOL. Methods: A convenience sample of 282 CRC patients 1 to 2 weeks postsurgery participated in an observational, cross-sectional study. Participants completed the following self-report measures: Body Image Scale, Distress Thermometer, Hospital Anxiety and Depression Scale, and Core Quality of Life Questionnaire. Results: The temporary stoma group (TS) and the permanent stoma group (PS) reported worse body image and higher levels of anxiety and depression than the non-stoma group (P < .05). PS reported worse body image than TS (P < .01). Depression and significant body image problems were more prevalent in PS than in TS (P < .05). Stoma status was the strongest factor associated with body image, distress, and depression (P < .05). CRC patients who were younger or in later clinical stages had poorer body image. Body image fully mediated the effect of stoma status on anxiety, depression, and global QOL in PS and TS, but mediated the effect on distress only in PS. Conclusions: Body image problems are common in stoma patients in the early postoperative stage and require early assessment. This study helps to elucidate the role of body image as a mediator. Longitudinal studies are needed to further explore body image distress trajectories. K E Y W O R D S anxiety, body image, cancer, China, colorectal, depression, distress, oncology, quality of life

Body image in colorectal cancer patients: A longitudinal study

“…Body image distress (BID) is an important psychosocial issue for cancer patients. BID is most prevalent in the immediate postoperative and treatment period, and prevalence rates range from 11% to 86% 2–5 . Research shows that 80% of Chinese CRC patients report BID in the early postoperative stage 2 .…”

“…Body image is a multidimensional concept that includes facets of cognition, behavior, and emotion relating to the entire body and its functioning 6 . BID is associated with higher levels of distress, anxiety, and depression 7,8 and is linked to lower sexual function 5 and poorer quality of life in CRC patients 2 . Several studies have shown that the presence of a stoma has a negative impact on body image, 7–9 especially for patients with a permanent stoma (PS) 2,9 .…”

“…BID is associated with higher levels of distress, anxiety, and depression 7,8 and is linked to lower sexual function 5 and poorer quality of life in CRC patients 2 . Several studies have shown that the presence of a stoma has a negative impact on body image, 7–9 especially for patients with a permanent stoma (PS) 2,9 . Reese et al.…”

The effect of phone counselling service on adaptation to stoma and quality of life among patients with intestinal stoma: a randomized controlled trial

“…In the study conducted by Zhang et al, on stoma patients it was reported that in the first one month patients called the line three times and therefore they reached the desired effect. In this study, it was found that the average number of phone counselling was 3.57±0.86 (2)(3)(4)(5) in weeks 1-6, and 1.97±0.56 (1-3) in weeks 7-10 and the number of phone counselling service decreased as long as patients adapted to living with stoma.…”

“…Stoma is a surgical intervention that negatively affects the quality of life, resulting in changes in the activities of daily living and the adopted life habits 1,2 . Patients with stoma go through problems with adaptation to stoma and thus they have difficulty in accepting their illnesses 3 . Patients with stoma experience some social, emotional, physical, sexual, and functional problems [4][5][6][7] .…”