Quality of life in patients with a permanent stoma after rectal cancer surgery

Abstract

AimHealth-related quality of life (HRQoL) assessment is important in understanding the patient’s perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.Methods711 patients operated for rectal cancer with abdomino-perineal resection or Hartman’s procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.Results336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.ConclusionOverall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

Living with a parastomal bulge ‐ patients’ experiences of symptoms

“…Moreover, humour might help patients reappraise stressful situations as less threatening (Manne et al., ) and serve as a stigma reducing strategy (Joachim & Acorn, ). In line with previous studies demonstrating impaired body image in patients with a parastomal bulge compared to stoma patients without, our findings indicate that patients’ body image changed (Mols, Lemmens, Bosscha, van den Broek, & Thong, ; Nasvall et al., ). However, perception of body image is not static (Pruzinsky, ) and patients also described adjustment to the bulge over time.…”

Psychosocial predictors of hope two years after diagnosis of colorectal cancer: Implications for nurse‐led hope programmes

“…Surgical treatments for colorectal cancer can alter bowel function, lead to sexual difficulties, reduce participation in leisure activities and work, and raise concerns about diet and appearance, such as clothing selection (Taylor, Bradshaw, Walker, & Wood, 2013). For those who receive pelvic radiotherapy and chemotherapy, a constellation of symptoms can last for months to years (Taylor et al, 2013), and these physical bodily changes can be distressing (Nasvall et al, 2017;Sharpe, Patel, & Clarke, 2011). Many people living with colorectal cancer also experience psychological distress (Chambers et al, 2012), which has been associated with high cancer threat appraisal (Lynch, Steginga, Hawkes, Pakenham, & Dunn, 2008).…”

Quality of life after end colostomy without mesh and with prophylactic synthetic mesh in sublay position: one-year results of the STOMAMESH trial

“…The presence of a stoma has a negative impact on qualityof-life (QoL) [1][2][3]. Complications arising from a stoma are common and varied; parastomal hernia (PSH) being one of the most frequent and important of these [4].…”