Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors

Abstract

Introduction Sexual dysfunction is a treatment sequela in rectal cancer (RC) survivors. Differences in health-related quality of life (HRQOL) may occur based on ostomy status (permanent ostomy versus anastomosis). Aim To describe alterations in sexual function and HRQOL based on ostomy status in long-term (≥ 5 years) RC survivors. Methods RC survivors with an ostomy (N=181) or anastomosis (N=394) were surveyed using validated HRQOL and functional status tools. We compared sexuality outcomes between the ostomy and anastomosis group, and reported differences adjusted for clinical and demographic characteristics. Qualitative data from one open-ended question on survivors’ greatest challenges since their surgery were analyzed to explore sexuality, symptoms, and relationships. Main Outcome Measures Whether sexually active, satisfaction with sexual activity, and select sexual dysfunction items from the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O). Results Survivors with a permanent ostomy were more likely to have been sexually inactive after surgery if it occurred before year 2000, and experience dissatisfaction with appearance, interference with personal relationships and intimacy, and lower overall HRQOL. Female RC survivors with an ostomy were more likely to have problems with vaginal strictures and vaginal pain after surgery that persisted at the time of survey (5+ years later). Radiation treatment, tumor stage, soilage of garments in bed, and higher Charlson-Deyo co-morbidity scores were negatively associated with outcomes. Six qualitative themes emerged: loss of and decreased sexual activity; psychological issues with sexual activity, physical issues with sexual activity; partner rejection; ostomy interference with sexual activity; and positive experiences with sexuality. Conclusions Sexual dysfunction is a common long-term sequela of RC treatment, with more problems observed in survivors with a permanent ostomy. This warrants widespread implementation of targeted interventions to manage sexual dysfunction and improve HRQOL for these survivors.

Health-Related Quality of Life Assessment in Patients With Rectal Cancer Treated With Curative Intent

“…Regarding our sample size, we can verify that it is inferior to most of the other published studies, whose samples ranged from 21 to 575 cases (1,2,6,7,(16)(17)(18) . However, it is worth emphasizing that the studies with the largest number of cases were multicentric, with one involving up to 30 services from eight different nationalities (18) , which could even be criticized for including people from different cultures, religions and nationality that would certainly make the sample very heterogeneous and with different perceptions about quality of life.…”

“…However, it remains implicit that there are changes in the habitual way of living after the treatment of rectal cancer. In the presence or absence of a stoma, which certainly alters the body image (7) , the surgical procedure itself will bring about physiological changes, of body image that can clearly be felt by the patients, especially at first moment. The preparation of a stoma may bring about perceptions of physical and emotional limitation, due to the alterations in the body image with the exteriozation of the intestinal loop, absence of control of feces and gas.…”

“…Sun et al (7) in a US study found that women with stoma had difficulties with self-image and were more likely to be rejected by their partners.…”

“…A review of 54 published studies on quality of life after surgical treatment of RC showed that the patients presented a series of physical problems, mainly related to sexual performance and to the urinary and intestinal functions (4) . Several other studies have shown important changes in quality of life in relation to physical, psychological and social limitations, among others (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) . Understanding that for many reasons the quality of life can be significantly altered in the treatment of rectal cancer, we propose to study the quality of life in a specialized cancer center in order to increase knowledge about the characteristics of these patients and the immediate and late consequences of their treatment.…”

Empowering survivors after colorectal and lung cancer treatment: Pilot study of a Self-Management Survivorship Care Planning intervention

“…Colorectal cancer survivors experience bowel dysfunction, pain, fatigue, and sexual dysfunction that negatively affects their quality of life (QOL) (Bours et al, 2016; Gosselin et al, 2016; Sun et al, 2015; Sun et al, 2016; Walling et al, 2015). Among rectal cancer survivors, permanent colostomies represent a major life adjustment (McMullen et al, 2016; Sun et al, 2013; Wright et al, 2015).…”