Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

Abstract

BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

Exploration of information and support needs in relation to health concerns, diet and physical activity in colorectal cancer survivors

“…Participants with a stoma reported receiving limited support but desired more support and information in relation to an appropriate diet to manage their bowel changes and prevent diarrhoea. Concerns related to uncontrollable bowel movements have been found elsewhere (Beaver et al., ; Nikoletti et al., ; Sun et al., ). However, findings from the present study differ to those from previous research that suggests patients with a stoma have more adjustment problems compared to patients without a stoma (Rozmovits, Rose, & Ziebland, ; Worster & Holmes, ).…”

Physical activity, bowel function, and quality of life among rectal cancer survivors

“…Changes in BF are often not addressed by clinicians [47], and RC survivors are left to discover their optimal modalities to control their BF. These may include modifications in diet, medications and supplements, meal-related behaviors, and PA [48]. Our survey was designed to probe these trial-and-error adaptations that RC survivors make to control their BF [29].…”

Cancer survivorship: Advancing the concept in the context of colorectal cancer

“…CRC survivors' quality of life (QOL) may be negatively influenced by the presence of an ostomy, level of physical activity and the experience of chronic symptoms including pain, fatigue, anxiety, changes in bowel habit and sexual dysfunction, with some variation in these effects between genders (Chambers et al, 2012b;Di Fabio et al, 2008;Domati et al, 2011;Krouse et al, 2009;Lynch et al, 2007bLynch et al, , 2008aLynch et al, , 2011Milbury et al, 2013;Peddle et al, 2008a;Ristvedt and Trinkaus, 2009;Sun et al, 2015;ThraenBorowski et al, 2013). Despite this, survivors' rate their health and QOL positively, in some cases improving over time, with long-term survivors reporting QOL levels comparable to normative populations (Caravati-Jouvenceaux et al, 2011;Chambers et al, 2012aChambers et al, , 2012bDi Fabio et al, 2008;Jansen et al, 2011;Phipps et al, 2008;Ristvedt and Trinkaus, 2009;Serpentini et al, 2011;Soerjomataram et al, 2012;Steginga et al, 2009;Thong et al, 2011aThong et al, , 2011b.…”

“…Changes in diet are as much to do with attaining a sense of control over bowel function or ostomy output, as it is to control the disease trajectory, and prevent recurrence (Anderson et al, 2013;Esplen et al, 2007;Grant et al, 2011;McMullen et al, 2008;Nikoletti et al, 2008;Palmer et al, 2013;Pullar et al, 2012;Sun et al, 2015). Bowel control is a significant challenge for CRC survivors, and a systematic regime of medication, dietary management and selfdevised management strategies are developed by survivors to manage bowel dysfunction (Desnoo and Faithfull, 2006;Grant et al, 2012;Nikoletti et al, 2008;Sun et al, 2015).…”